Outcomes of antifungal prophylaxis for newly diagnosed AML patients treated with a hypomethylating agent and venetoclax
Evan C. Chen, Yiwen Liu, Courtney E. Harris, Eric S. Winer, Martha Wadleigh, Andrew A. Lane, Rahul S. Vedula, R. Coleman Lindsley, Kevin Copson, Anne Charles, Francisco M. Marty, Donna Neuberg, Daniel J. DeAngelo, Richard M. Stone, Marlise R. Luskin, Nicolas C. Issa, Jacqueline S. Garcia
Abstract
Antifungal prophylaxis (AFP) is recommended for acute myeloid leukemia (AML) patients receiving the combination of venetoclax (VEN) and a hypomethylating agent (HMA), but the benefit of this practice is unclear. We identified 131 patients with newly diagnosed AML who received frontline VEN/HMA and evaluated the use of AFP and its association with invasive fungal infections (IFIs) and AML outcomes. Seventeen percent of our patients received AFP at any time. Overall incidence of any IFI (‘possible,’ ‘probable,’ or ‘proven’ infection, as defined by the European Mycoses Study Group) was 13%, and the incidence did not differ based on AFP use (p=.74). Median overall survival did not differ based on AFP use or lack thereof (8.1 vs. 12.5 months, respectively; p=.14). Our findings suggest that, at an institution where the incidence of fungal infections is low, there does not appear to be a role for AFP in newly diagnosed AML patients receiving VEN/HMA.