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Antifungal prophylaxis in adult patients with acute myeloid leukaemia treated with novel targeted therapies: a systematic review and expert consensus recommendation from the European Hematology Association.

Author: Ben-AmiRonen, BrüggemannRoger J, BuscaAlessandro, CornelyOliver A, LewisRussell, PiechottaVanessa, RáčilZdeněk, SinkóJános, SkoetzNicole, StemlerJannik, de JongeNick

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Overview

Antifungal prophylaxis during remission induction chemotherapy is recommended for patients with acute myeloid leukemia. Many novel targeted agents are metabolized by cytochrome P450, leading to uncertainty about potential drug-drug interactions (DDIs) and their risk-benefit ratio. This study provides recommendations on the role of antifungal prophylaxis and the management of pharmacokinetic DDIs with triazole antifungals, based on a systematic literature review. Antifungal prophylaxis is moderately recommended in most settings and strongly recommended if the novel acute myeloid leukemia agent is administered in combination with intensive induction chemotherapy. For ivosidenib, lestaurtinib, quizartinib, and venetoclax, we moderately recommend adjusting the dose of the antileukaemic agent during administration of triazoles. Future studies are needed to determine the role of dosage adjustment of novel antileukaemic drugs during concomitant administration of CYP3A4-inhibiting antifungals.
Paper Details　
Original Abstract of the Article :
On the basis of improved overall survival, treatment guidelines strongly recommend antifungal prophylaxis during remission induction chemotherapy for patients with acute myeloid leukaemia. Many novel targeted agents are metabolised by cytochrome P450, but potential drug-drug interactions (DDIs) and ...See full text at original site
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引用元：
https://doi.org/10.1016/S2352-3026(22)00073-4

データ提供：米国国立医学図書館（NLM）

Antifungal Prophylaxis in Patients with Acute Myeloid Leukemia: A Systematic Review

The field of hematology is always on the move, and the treatment of acute myeloid leukemia (AML) is no exception. In this systematic review, experts from the European Hematology Association addressed a crucial issue in AML treatment: antifungal prophylaxis. Novel targeted therapies are becoming increasingly popular in AML treatment, but their effects on the body's immune system, and the subsequent risk of fungal infections, need careful consideration. This review aimed to provide evidence-based recommendations for antifungal prophylaxis in patients receiving these new treatments.

The Role of Antifungal Prophylaxis in AML Treatment

The authors found that antifungal prophylaxis is strongly recommended when novel AML agents are used in combination with intensive induction chemotherapy. This is because these treatments can significantly suppress the immune system, making patients more susceptible to fungal infections. For other settings, such as patients with relapsed or refractory AML, moderate-strength recommendations for antifungal prophylaxis were given.

Navigating Drug Interactions: A Balancing Act

Many of these novel targeted agents are processed by the liver enzyme CYP3A4. Triazole antifungals, commonly used for prophylaxis, also interact with this enzyme, which can lead to potential drug-drug interactions (DDIs). To address this, the review recommends adjusting the dose of certain AML agents when triazoles are administered. This underscores the importance of careful monitoring and individualized treatment plans.

Dr. Camel's Conclusion

This research, like a camel traversing the vast desert of medical knowledge, has shed light on the importance of antifungal prophylaxis in patients with AML receiving novel therapies. It's crucial to understand the complex interplay between new treatments, the immune system, and the potential for fungal infections. This research encourages further studies, like a caravan of researchers, to explore the optimal dosage adjustments of novel antileukaemic drugs in the presence of CYP3A4-inhibiting antifungals. This will help us navigate the intricate desert landscape of AML treatment with greater precision and care.

Date :
  1. Date Completed 2022-05-02
  2. Date Revised 2022-07-05
Further Info :

Pubmed ID

35483397

DOI: Digital Object Identifier

10.1016/S2352-3026(22)00073-4

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Languages

English

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