Antifungal Prophylaxis Decreases Induction Mortality Rates in Pediatric AML
SAN FRANCISCO, CA— Antifungal prophylaxis is associated with significant reduction in induction mortality rates in pediatric acute myeloid leukemia (AML) patients and reduced supportive care resources utilization, reported study researchers at IDWeek 2013.
The effectiveness of antifungal prophylaxis in pediatric patients with prolonged neutropenia is not well established. Brian Fisher, DO, MSCE, from The Children's Hospital of Philadelphia, in Philadelphia, PA and colleagues conducted a retrospective observational cohort study to determine the impact of antifungal prophylaxis on induction mortality and on supportive care resources in children with de novo acute myeloid leukemia (AML).
Using the Pediatric Health Information System database, children aged 0–18 years with newly diagnosed AML receiving induction chemotherapy at one of 43 US free-standing children's hospitals between January 1, 1999 to March 31, 2010 were included. Patients were followed until the end of induction, death, or loss to follow-up.
Cox regression analyses were used to compare the induction mortality and resources utilized between patients receiving and not receiving antifungal prophylaxis. A propensity score accounted for variation in demographic factors, location of care, and severity of illness at presentation.
Antifungal prophylaxis was associated with a significant reduction in resource usage compared to no antifungal prophylaxis in regards to:
- Broad gram-positive antibiotics (258.7 vs. 215.9, adjusted HR 0.87; 95% CI 0.79–0.97),
- Beta-lactam anti-Pseudomonas coverage (456.9 vs. 407.8, adjusted HR 0.91; 95% CI 0.85–0.96),
- Blood cultures (184.1 vs. 136.9, adjusted HR 0.78; 95% CI 0.71–0.86), and
- Chest CT scans (14.1 vs. 11.8, adjusted HR 0.73; 95% CI 0.60–0.88)
Based on small event rates it is not clear from the data if antifungal prophylaxis that retains anti-mold activity is superior to prophylaxis that does not have anti-mold coverage.
“Antifungal prophylaxis should be considered for children with AML,” concluded Dr. Fisher. He added, “Randomized trials are needed to determine if antifungal prophylaxis with anti-mold activity is superior to non-mold active antifungal prophylaxis.”