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Remisyon İndüksiyon Kemoterapisinde Posakonazol Proflaksisi Ne Zaman Başlanmalı?

Year 2020, Volume: 5 Issue: 2, 1 - 4, 01.08.2020

Abstract

Amaç: Akut Myeloid Lösemi (AML) tanısı alan ve remisyon indüksiyon kemoterapisi verilen hastalarda gelişen invaziv fungal enfeksiyonların (İFE) mortalitesi yüksek seyretmektedir. Bu hastalarda antifungal profilaksi kullanımı önerilmektedir ancak antifungal profilaksinin, başlanma zamanı konusunda net bilgi yoktur. Bu çalışmada, remisyon indüksiyon kemoterapisi alan hastalarda, kemoterapi ile başlanan antifungal profilaksinin etkinliği ile hasta nötropeniye girdikten sonra başlanan başlanan posakonazol profilaksisinin etkinliğini değerlendirmek amaçlanmıştır.
Gereç-Yöntem: AML tanısı ile remisyon indüksiyon kemoterapisi alan hastalarda, hasta nötropeniye girdikten sonra başlanan posakonazol profilaksisi (Grup 1) ile kemoterapi rejimiyle birlikte posakonazol profilaksisi (Grup 2) arasındaki farklar karşılaştırıldı. Hastaların demografik verileri ve gelişen İFE’lar kaydedildi.
Bulgular: Çalışma süresince, AML tanısı ile remisyon indüksiyon kemoterapisi alan 104 hasta çalışmaya alındı. Birinci grupta 46 hasta, ikinci grupta ise 58 hasta vardı. Profilaksi etkinliği karşılaştırıldığında ise birinci grupta 22 (%47.8) ikinci grupta 19 (32.8) hastada başarısızlık görüldü. Her iki grubun demografik verileri benzer idi ancak 21 günden uzun nötropeni varlığı grup 1’de daha fazla bulundu. Ayrıca grup 1’de ortalama nötropeni süresi daha uzun idi (p<0.001).
Sonuç: Posakonazol profilaksisi kemoterapi ile başlanan Grup 2’de İFE sıklığı %22.4 bulundu. Her iki grup arasında hasta özellikleri arasında fark olmasına rağmen, kemoterapi ile birlikte başlanan antifungal profilaksinin, IFE gelişmesini önlemede daha etkin olduğu düşünülmüştür. Çünkü posakonazolun serum kararlı durum konsantrasyonuna ulaşma süresi 6-10 gündür. KT ile posakonazol başlanan hastalarda, hastanın IFE için riskli olduğu dönemde posakonazol etkin konsantrasyona ulaşmış olacaktır.

References

  • 1. Pagano L, Caira M, Candoni A, Offidani M, Martino B, Specchia G, et al. (2010) invasive aspergillosis in patients with acute myeloid leukemia: SEIFEM-2008 registry study. Haematologica. 2010; 95(4):644–50.
  • 2. Neofytos D1, Lu K, Hatfield-Seung A, Blackford A, Marr KA, Treadway S, ett al. Epidemiology, outcomes, and risk factors of invasive fungal infections in adult patients with acute myelogenous leukemia after induction chemotherapy. Diagn Microbiol Infect Dis. 2013;75(2):144-9. doi: 10.1016/j.diagmicrobio.2012.10.001. Epub 2012 Nov 8.
  • 3. Maertens JA, Girmenia C, Brüggemann RJ, Duarte RF, Kibbler CC, Ljungman P, et al. European guidelines for primary antifungal prophylaxis in adult haematology patients: summary of the updated recommendations from the European Conference on Infections in Leukaemia. J Antimicrob Chemother. 2018;73(12):3221-3230.
  • 4. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008;46:1813–1821
  • 5. Nganthavee V, Phutthasakda W1, Atipas K, Tanpong S, Pungprasert T, Dhirachaikulpanich D. High incidence of invasive fungal infection during acute myeloid leukemia treatment in a resource-limited country: clinical risk factors and treatment outcomes. Support Care Cancer. 2019;27(9):3613-3622.
  • 6. Courtney R, Pai S, Laughlin M, Lim J, Batra V. Pharmacokinetics, safety, and tolerability of oral posaconazole administered in single and multiple doses in healthy adults. Antimicrob Agents Chemother. 2003;47:2788–95.
  • 7. Ullmann AJ, Cornely OA, Burchardt A, Hachem R, Kontoyiannis DP, Töpelt K, et al. Pharmacokinetics, safety, and efficacy of posaconazole in patients with persistent febrile neutropenia or refractory invasive fungal infection. Antimicrob Agents Chemother. 2006;50:658–66.
  • 8. Gubbins PO, Krishna G, Sansone-Parsons A, Penzak SR, Dong L, Martinho M, et al. Pharmacokinetics and safety of oral posaconazole in neutropenic stem cell transplant recipients. Antimicrob Agents Chemother. 2006;50:1993–9.
  • 9. Krishna G, Moton A, Ma L, Medlock MM, McLeod J. Pharmacokinetics and absorption of posaconazole oral suspension under various gastric conditions in healthy volunteers. Antimicrob Agents Chemother. 2009;53(3):958–966.
Year 2020, Volume: 5 Issue: 2, 1 - 4, 01.08.2020

Abstract

References

  • 1. Pagano L, Caira M, Candoni A, Offidani M, Martino B, Specchia G, et al. (2010) invasive aspergillosis in patients with acute myeloid leukemia: SEIFEM-2008 registry study. Haematologica. 2010; 95(4):644–50.
  • 2. Neofytos D1, Lu K, Hatfield-Seung A, Blackford A, Marr KA, Treadway S, ett al. Epidemiology, outcomes, and risk factors of invasive fungal infections in adult patients with acute myelogenous leukemia after induction chemotherapy. Diagn Microbiol Infect Dis. 2013;75(2):144-9. doi: 10.1016/j.diagmicrobio.2012.10.001. Epub 2012 Nov 8.
  • 3. Maertens JA, Girmenia C, Brüggemann RJ, Duarte RF, Kibbler CC, Ljungman P, et al. European guidelines for primary antifungal prophylaxis in adult haematology patients: summary of the updated recommendations from the European Conference on Infections in Leukaemia. J Antimicrob Chemother. 2018;73(12):3221-3230.
  • 4. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008;46:1813–1821
  • 5. Nganthavee V, Phutthasakda W1, Atipas K, Tanpong S, Pungprasert T, Dhirachaikulpanich D. High incidence of invasive fungal infection during acute myeloid leukemia treatment in a resource-limited country: clinical risk factors and treatment outcomes. Support Care Cancer. 2019;27(9):3613-3622.
  • 6. Courtney R, Pai S, Laughlin M, Lim J, Batra V. Pharmacokinetics, safety, and tolerability of oral posaconazole administered in single and multiple doses in healthy adults. Antimicrob Agents Chemother. 2003;47:2788–95.
  • 7. Ullmann AJ, Cornely OA, Burchardt A, Hachem R, Kontoyiannis DP, Töpelt K, et al. Pharmacokinetics, safety, and efficacy of posaconazole in patients with persistent febrile neutropenia or refractory invasive fungal infection. Antimicrob Agents Chemother. 2006;50:658–66.
  • 8. Gubbins PO, Krishna G, Sansone-Parsons A, Penzak SR, Dong L, Martinho M, et al. Pharmacokinetics and safety of oral posaconazole in neutropenic stem cell transplant recipients. Antimicrob Agents Chemother. 2006;50:1993–9.
  • 9. Krishna G, Moton A, Ma L, Medlock MM, McLeod J. Pharmacokinetics and absorption of posaconazole oral suspension under various gastric conditions in healthy volunteers. Antimicrob Agents Chemother. 2009;53(3):958–966.
There are 9 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Makale
Authors

Esma Eren 0000-0002-2712-9694

Ayşegül Ulu Kılıç 0000-0002-4454-374X

Leylagül Kaynar 0000-0002-2035-9462

Publication Date August 1, 2020
Acceptance Date August 1, 2020
Published in Issue Year 2020 Volume: 5 Issue: 2

Cite

Vancouver Eren E, Ulu Kılıç A, Kaynar L. Remisyon İndüksiyon Kemoterapisinde Posakonazol Proflaksisi Ne Zaman Başlanmalı?. JAMER. 2020;5(2):1-4.