International Clinical and Medical Case Reports Journal (ISSN: 2832-5788) | Volume 3, Issue 6 | Research Article | Open Access DOI
Afnan Alamri*
Afnan Y. Alamri1*, Mansoor A. Khan2, Mohammed A. Aseeri3, Ahmed A. Absi4 and Abdelmajid H. Alnatsheh5
1Department of Internal Medicine, Board Certified Pharmacotherapy Specialist and Board-Certified Nutrition Support Pharmacist, Saudi Arabia
2Department of Oncology/ Hematology, Board Certified Pharmacists, Saudi Arabia
3Department of Oncology/ Hematology, Board Certified Pharmacotherapy Specialist, FISMP, Saudi Arabia
4Department of Oncology/ Hematology, Saudi Arabia
5Department of Oncology/ Hematology, Board Certified Pharmacists, Board-Certified Nutrition Support Pharmacist, Saudi Arabia
*Correspondence to: Afnan Alamri
Fulltext PDF1.1. Background: Fungal infection is common in Acute Lymphocytic Leukaemia (ALL), which can lead to significant mortality and morbidity. Our aim is to compare the efficacy of antifungal prophylaxis using fluconazole 400 mg once daily versus Amphotericin B lipid complex 2.5 mg/kg three times per week in adult ALL patients during the neutropenic nadir who received Hyper-CVAD as part of their chemotherapy regimen.
1.2. Methods: It was a retrospective, cohort chart review study conducted on eligible ALL patients who received Hyper-CVAD based chemotherapy regimen between January 1, 2007, and December 31, 2016, at KAMC, Jeddah. We included ALL patients who completed at least one course of Hyper-CVAD and received antifungal prophylaxis with age >14 years. We excluded patients who received BFM regimen. Data have been collected using hospital information system. The primary endpoint was the incidence of fungal infection, which was assessed using microbiology data and imaging studies for radiological evidence of fungal infections. The secondary endpoints were to assess QTc prolongation in Ph+ve ALL that is associated with fluconazole use in combination with TKI and lastly cost impact based on the type of antifungal prophylaxis used.
1.3. Results: A total of 105 cycles of Hyper-CVAD were reviewed. In 70 cycles, fluconazole was used as antifungal prophylaxis (n = 70) and in 35 cycles amphotericin B lipid complex was used (n = 35) as antifungal prophylaxis. Microbiologically documented fungal infection have been found in 2 out of 70 cycles in fluconazole arm and radiologically documented fungal infections was found in one patient in the fluconazole group. QTc prolongation was observed in 12 cycles. In 9 out of 12 cycles, events of QTc prolongation observed during the study, fluconazole was used as antifungal prophylaxis and patients were on TKI. In 3 out of 12 cycles, events of QTc prolongation were observed during the study, amphotericin B Lipid Complex was used as antifungal prophylaxis and patients were on TKI.
1.4. Conclusion: Fluconazole is considered a standard antifungal prophylaxis in ALL patients with acceptable safety profiles. Fluconazole had comparable efficacy to Amphotericin lipid complex. Fluconazole may cause QTc prolongation when used in combination with TKIs and need to monitor the patients more closely when this combination is used in Ph+Ve ALL patients.
Afnan Y. Alamri, Mansoor A. Khan, Mohammed A. Aseeri, Ahmed A. Absi, Abdelmajid H. Alnatsheh. Comparing Antifungal Prophylaxis Efficacy Between Fluconazole and Amphotericin B Lipid Complex in Adult Acute Lymphocytic Leukaemia and Acute Lymphoblastic Lymphoma (ALL) Patients Receiving Hyper-CVAD Based Chemotherapy. Int Clinc Med Case Rep Jour. 2024;3(6):1-9.