scholarly journals Pharmacoeconomic evaluation of fluconazole, posaconazole and voriconazole for antifungal prophylaxis in patients with acute myeloid leukaemia undergoing first consolidation chemotherapy

2013 ◽  
Vol 68 (7) ◽  
pp. 1669-1678 ◽  
Author(s):  
S.-C. Heng ◽  
M. A. Slavin ◽  
D. Al-Badriyeh ◽  
S. Kirsa ◽  
J. F. Seymour ◽  
...  
Keyword(s):  
Acute Myeloid Leukaemia ◽  
Myeloid Leukaemia ◽  
Pharmacoeconomic Evaluation ◽  
Antifungal Prophylaxis ◽  
Consolidation Chemotherapy ◽  
Acute Myeloid

scholarly journals When azoles cannot be used: the clinical effectiveness of intermittent liposomal amphotericin prophylaxis in haematology patients

2021 ◽  
Author(s):  
R Batchelor ◽  
C Thomas ◽  
B J Gardiner ◽  
S J Lee ◽  
S Fleming ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Acute Myeloid Leukaemia ◽  
Myeloid Leukaemia ◽  
Liposomal Amphotericin ◽  
Kidney Injury ◽  
Antifungal Prophylaxis ◽  
High Rate ◽  
Clinical Scenarios ◽  
Haematology Patients ◽  
Acute Myeloid

Abstract Background Patients unable to take azoles are a neglected group lacking a standardized approach to antifungal prophylaxis. We evaluated the effectiveness and safety of intermittent liposomal amphotericin (L-AMB) prophylaxis in a heterogenous group of haematology patients. Methods A retrospective cohort of all haematology patients who received a course of intravenous L-AMB defined as 1mg/kg thrice weekly, from 1 July 2013-30 June 2018 were identified from pharmacy records. Outcomes included breakthrough-invasive fungal disease (BIFD), reasons for premature discontinuation and acute kidney injury. Results There were 198 patients who received 273 courses of L-AMB prophylaxis. Using a conservative definition, the BIFD rate was 9.6% (n=19/198) occurring either during L-AMB prophylaxis or up to 7 days from cessation in patients who received a course. Probable/proven-BIFD occurred in 13 patients (6.6%, 13/198), including molds in 54% (n=7) and non-albicans Candidaemia in 46% (n=6). Cumulative incidence of BIFD was highest in patients with acute myeloid leukaemia (6.8%) followed by acute lymphoblastic leukaemia (2.7%) and allogeneic stem cell transplantation (2.5%). The most common indication for L-AMB was chemotherapy or anticancer drug-azole interactions (75% of courses) dominated by vincristine or acute myeloid leukaemia clinical trials, followed by gut absorption concerns (13%) and liver function abnormalities (8.8%). Acute kidney injury using a modified international definition, complicated 27% of courses but was not clinically significant accounting for only 3.3% (9/273) of discontinuations. Conclusions Our findings demonstrate a high rate of BIFD among patients receiving L-AMB prophylaxis. Pragmatic trials will help find the optimal regimen of L-AMB prophylaxis for the many clinical scenarios where azoles are unsuitable, especially as targeted anticancer drugs increase in use.

scholarly journals Use of Human Granulocyte Colony-Stimulating Factor (G-CSF) in Consolidation Chemotherapy in Adult Acute Myeloid Leukaemia (AML)

2019 ◽  
Vol 47 (2) ◽  
pp. 23-28
Author(s):  
Muhammad Shahidul Islam Sikder Rumi ◽  
ABM Yunus ◽  
Amin Lutful Kabir ◽  
Masuda Begum ◽  
Naseeb Muhammad Irshadullah ◽  
...  
Keyword(s):  
Acute Myeloid Leukaemia ◽  
Myeloid Leukaemia ◽  
Absolute Neutrophil Count ◽  
Neutrophil Count ◽  
Granulocyte Colony Stimulating Factor ◽  
Colony Stimulating Factor ◽  
Consolidation Chemotherapy ◽  
Consolidation Phase ◽  
Stimulating Factor ◽  
Acute Myeloid

Acute myeloid leukaemia (AML) is treatable and potentially curable disease. Significant morbidity is related to the prolonged, severe neutropenia resulting from the disease as well as the intensive chemotherapy. The administration of granulocyte - colony stimulating factor (G-CSF) is recommended to reduce the neutropenic period. But the current information and guidelines are insufficient about the most appropriate time to start   G-CSF and the optimum duration of treatment after chemotherapy in consolidation phase. This study explores  better timing to start G-CSF after completion of chemotherapy in consolidation phase of AML patient. This prospective study was conducted in the department of Haematology, Bangabandhu Sheikh Mujib Medical University among AML patients, who received consolidation chemotherapy (high dose cytarabine). Samples were grouped into two arms. Arm-A (Absolute Neutrophil Count >1000/cmm) received prophylactic G-CSF and Arm-B (Absolute Neutrophil Count <1000/cmm) received G-CSF during neutropenia. Filgrastim was used as G-CSF and daily 300 micrograms were given subcutaneously according to study protocol. Statistical analysis was done by parametric (t test) test and appropriate using computer based SPSS (21) Program. Total sample was 19, out of which 6 in prophylactic G-CSF group (Arm-A) and 13 in delayed G-CSF group (Arm-B). Most of the patients were male (63.16%), male to female ratio 1.7:1 and mean age of sample 35 years. Mean ANC at the 1st day of G-CSF application in Arm-A 1170.5/cmm & in Arm-B 272.6/cmm (p=<0.001); mean requirements of G-CSF accordingly 11.5 and 5.9 (p=0.0014), mean 1st day of G-CSF application 9.5th day and 14.5th day (p=0.001). Outcomes in Arm-A and Arm-B were accordingly, mean duration of ANC recovery 10 and 9.85 days (p=0.913), febrile neutropenia 2.67 and 2.57 days (p=0.961), hospital stay 20 and 20.3 days (p=0.259), red cell concentrate transfusion 1.83 and 1.46 units (p=0.550), platelets concentrate transfusion 11.83 and 7.77 bags (p=0.2405), and there was no death case in two arms. Differences of timing to start G-CSF and its requirements between two groups were significant, but the outcomes did not show any statistically significant difference. Bangladesh Med J. 2018 May; 47 (2): 23-28

The acute myeloid leukaemia market

2019 ◽  
Vol 19 (4) ◽  
pp. 233-234
Author(s):  
Jorrit Schaefer ◽  
Sorcha Cassidy ◽  
Rachel M. Webster
Keyword(s):  
Acute Myeloid Leukaemia ◽  
Myeloid Leukaemia ◽  
Acute Myeloid
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