Failed posaconazole prophylaxis: A case of breakthrough cutaneous mucormycosis in an elderly neutropenic gentlemen with acute myeloid leukemia
Case: A 71-year-old male with acute myeloid leukemia (AML) on posaconazole for invasive fungal disease prophylaxis was found to have necrotic, escharred skin lesions on his bilateral forearms that developed while awaiting resolution of chemotherapy-induced neutropenia. 4-mm punch biopsies were performed through the necrotic center of each lesion and frozen sections were sent for investigation. Right forearm skin biopsy and frozen section were positive for angioinvasive fungal infection within the dermis and subcutis, which demonstrated vascular occlusion by numerous fungal hyphae.
AbstractBackground Patients with haematological malignancies are at high risk of invasive fungal infections. However, there is a lack of information about the utilisation of the recommended Australian antifungal prophylaxis guidelines in haematology outpatients.Objective To assess the impact of a weekly pharmacist review of high-risk adult haematology outpatients on the utilisation of appropriate antifungal prophylaxis.Setting Outpatient cancer centre, tertiary referral hospital in Sydney, Australia.Method A 3-month pre-and post-interventional study was conducted. A retrospective audit was conducted to obtain baseline util...
The aim of our study was to selectively analyze newly diagnosed acute myeloid leukemia patients treated with a hypomethylating agent and establish their risk for developing invasive fungal infections (IFI). We stratified patients into concern for IFI (cIFI) versus no concern, and observed that patients of the male gender and those with underlying chronic obstructive pulmonary disease (COPD) are at higher risk for cIFI, which may prompt clinicians to consider anti-mold prophylaxis in this setting.
The aim of our study was to selectively analyze newly diagnosed patients with acute myeloid leukemia treated with a hypomethylating agent and establish their risk for developing invasive fungal infections (IFIs). We stratified patients into concern for IFI versus no concern, and observed that patients of the male gender and those with underlying chronic obstructive pulmonary disease are at higher risk for concern for IFI, which may prompt clinicians to consider anti-mold prophylaxis in this setting.
Publication date: Available online 26 June 2020Source: Clinical Lymphoma Myeloma and LeukemiaAuthor(s): Jessie Signorelli, Matthew Lei, Jenna Lam, Marla Jalbut, Philip C. Amrein, Amir T. Fathi, Gabriela Hobbs, Hanno Hock, Steven Lawrence McAfee, Alyssa R. Letourneau, Rupa Narayan, Andrew Brunner
AbstractWith the advent of new targeted drugs in hematology and oncology patient prognosis is improved. Combination with antifungal prophylaxis challenges clinicians due to pharmacological profiles prone to drug –drug interactions (DDI). Midostaurin is a novel agent forFLT3-TKD/-ITDmut-acute myeloid leukemia (AML) and metabolized via cytochrome P450 3A4 (CYP3A4). Posaconazole is a standard of care antifungal agent used for prophylaxis during induction treatment of AML and a strong CYP3A4 inhibitor. Concomitant administration of both drugs leads to elevated midostaurin exposure. Both drugs improve overall survival at ...
ConclusionIn Chinese AML patients, the posaconazole 300-mg tablet provided PK data comparable with those of previous studies and was generally well tolerated and efficacious.Clinical Trial RegistrationClinicalTrials.gov, NCT02387983.
To the Editor Dr Fisher and colleagues examined prevention of invasive fungal infections in neutropenic patients aged 3 months to 30 years with acute myeloid leukemia with caspofungin vs fluconazole. Caspofungin resulted in a statistically significant lower incidence of invasive fungal disease. However, prophylaxis depends on appropriateness and adequacy of the antifungal medication.
Fusariosis is a fungal infection that affects immunocompromised hosts and is mainly fatal in its disseminated form. A 49-year-old male patient with acute myeloid leukemia, hepatic and splenic infiltration, thrombocytopenia, odynophagia, and abdominal pain was referred for evaluation. Clinical examination revealed nasal and small oral ulcers with erythematous halo on the soft palate, and diagnostic hypotheses were bacterial or viral infection. Treatment with cefepime and vancomycin, local hygiene, and low-level laser therapy were adopted, and lesions presented remission.
In conclusion, twoDectin-1 SNPs (rs3901533 and rs7309123) are associated with increased susceptibility to pulmonary IFD in AML patients in a Chinese Han population.