ANTIFUNGAL PROPHYLAXIS DURING REMISSION INDUCTION THERAPY FOR ACUTE-LEUKEMIA FLUCONAZOLE VERSUS INTRAVENOUS AMPHOTERICIN-B

Background. Fungal infection is a frequent and often fatal complicatio n in patients undergoing remission induction therapy for acute leukemi a. Although candidiasis is the most common infection, mold infections are increasing in frequency. Fluconazole (FLU) is a new antifungal age nt that has been used successfully to treat Candida infections and has modest activity against aspergillosis in animal models. Subtherapeuti c doses of amphotericin B (AMB) have been considered effective as prop hylaxis in these patients. This study was designed to compare the effi cacy and toxicity of these agents as antifungal prophylaxis. Methods. Adults with acute leukemia undergoing remission induction chemotherapy randomly were assigned to receive antifungal prophylaxis with AMB (0. 5 mg/kg three times weekly) or FLU (400 mg daily). Trimethoprim-sulfam ethoxazole was administered as an antibacterial prophylaxis. Prophylax is was continued until the patient achieved complete remission or was treated for 8 weeks without antileukemic response. Prophylaxis was dis continued if the patient experienced a possible or proven fungal infec tion or a serious toxicity. Results. Overall, 58% of the 36 patients a ssigned to AMB successfully completed prophylaxis compared with 80% of the 41 patients assigned to FLU (< 0.05). Proven, probable, or possib le fungal infections occurred in 31% and 17% of the patients, respecti vely. The risk of discontinuing prophylaxis due to fungal infection or toxicity increased with time in the study and was significantly great er for AMB (P = 0.02). Conclusions. At the dose used in this study, AM B was no more effective and was more toxic than FLU for prophylaxis of fungal infections in patients undergoing remission induction chemothe rapy for acute leukemia.