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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2016; 37(01): 53-58
DOI: 10.4103/0971-5851.177032
ORIGINAL ARTICLE

Voriconazole is a safe and effective anti-fungal prophylactic agent during induction therapy of acute myeloid leukemia

Akash Shah
Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
,
Prasanth Ganesan
Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
,
Venkatraman Radhakrishnan
Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
,
Krishnarathinam Kannan
Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
,
Rejiv Rajendranath
Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
,
Vandana Mahajan
Department of Radiodiagnosis, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
,
Varalakshmi Vijayakumar
Department of Microbiology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
,
Trivadi Ganesan
Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
,
Tenali Sagar
Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Background: Antifungal prophylaxis (AFP) reduces the incidence of invasive fungal infections (IFIs) during induction therapy of acute myeloid leukemia (AML). Posaconazole is considered the standard of care. Voriconazole, a generic cheaper alternative is a newer generation azole with broad anti-fungal activity. There is limited data on the use of voriconazole as a prophylactic drug. Materials and Methods: A single-center, prospective study was performed during which patients with AML undergoing induction chemotherapy received voriconazole as AFP (April 2012 to February 2014). Outcomes were compared with historical patients who received fluconazole as AFP (January 2011-March 2012, n = 66). Results: Seventy-five patients with AML (median age: 17 years [range: 1-75]; male:female 1.6:1) received voriconazole as AFP. The incidence of proven/probable/possible (ppp) IFI was 6.6% (5/75). Voriconazole and fluconazole cohorts were well-matched with respect to baseline characteristics. Voriconazole (when compared to fluconazole) reduced the incidence of pppIFI (5/75, 6.6% vs. 19/66, 29%; P < 0.001), need to start therapeutic (empiric + pppIFI) antifungals (26/75, 34% vs. 51/66, 48%; P < 0.001) and delayed the start of therapeutic antifungals in those who needed it (day 16 vs. day 10; P < 0.001). Mortality due to IFI was also reduced with the use of voriconazole (1/75, 1.3% vs. 6/66, 9%; P = 0.0507), but this was not significant. Three patients discontinued voriconazole due to side-effects. Conclusion: Voriconazole is an effective and safe oral agent for IFI prophylaxis during induction therapy of AML. Availability of generic equivalents makes this a more economical alternative to posaconazole.

Keywords

Acute myeloid leukemia - anti-fungal prophylaxis - fluconazole - invasive fungal infection - voriconazole


Publication History

Article published online:
12 July 2021

© 2016. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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