Outcomes of antifungal prophylaxis for newly diagnosed AML patients treated with a hypomethylating agent and venetoclax

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.

Keywords:

• Acute myeloid leukemia
• antifungal
• prophylaxis
• fungal infection

Disclosure statement

ESW has provided consultancy to Takeda, Novartis, and AbbVie. AAL has received research funding from AbbVie and Stemline Therapeutics, and provided consultancy to Qiagen and N-of-One. DN has received research funding from Pharmacyclics. DJD has provided consultancy to Blueprint Medicines Corporation, Takeda, Autolus, Shire, Amgen, Agios, Forty-Seven, Pfizer, Incyte Corporation, Jazz, and Novartis, and received research funding from GlycoMimetics, AbbVie, and Novartis. RMS has served on the advisory committee of Syros, Astellas, Actinium, BerGen Bio, Gemoab, Syndax, and Elevate Bio, and provided consultancy to Innate, GlaxoSmithKline, Takeda, Aprea, Bristol Myers Squibb, Janssen, Jazz, Novartis, Arog, AbbVie, Celgene, and Macrogenics. JSG has served on the advisory committee of Takeda, Astellas, and AbbVie, and obtained research funding from AstraZeneca, Prelude, Pfizer, and Genentech. The remaining authors have no conflicts to disclose.

Additional information

Funding

JSG is supported by the National Cancer Institute (NCI) of the National Institutes of Health (NIH) under award number K08CA245209 Research is additionally supported by CA066996.