Evaluating the Effectiveness and Security of Antifungal Prophylaxis in Acute Lymphoblastic Leukemia Induction Chemotherapy

Background and objectives: Patients suffering from hematologic malignancies face a high risk of developing invasive fungal disease (IFD). Primary antifungal prophylaxis (PAP) is a key strategy to reduce the incidence of IFD in patients with acute myeloid leukemia (AML), those receiving hematopoietic stem cell transplantation (HSCT), and those with myelodysplastic syndrome (MDS). Nonetheless, clinical data regarding PAP in ALL patients is scarce, owing to major drug interactions. This paper aims to evaluate the efficacy and safety of PAP in ALL patients through real-world research. Methods: A retrospective cohort study was carried out at a single center, focusing on ALL patients aged over 14 who received their first induction chemotherapy at our hospital from January 2011 to January 2021. Our study excluded individuals with a background of IFD, those who declined treatment and were released from the hospital, and those whose cases were inaccessible. The identification of IFD adhered to the guidelines set by the European Organization for Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG). Results: The study included 482 patients, 316 of whom undergoing PAP treatment. Of the 482 patients, 13 developed proven or probable IFD (2.7%), and 60 developed possible IFD. There was a notably reduced occurrence of IFD in the prevention group compared to the non-prevention group (36/316, 11.4% vs. 37/166, 22.3%, P = 0.002). The multifactorial Cox regression analysis revealed a notable decrease in IFD occurrences due to PAP (HR = 0.306, P < 0.001). The primary medications administered in PAP included caspofungin (n = 113), voriconazole (n = 99), and micafungin (n = 53). The caspofungin group exhibited no adverse drug reactions. Patients experiencing neutropenia for more than 10 days and those on corticosteroids for 7 days or more showed a reduced mortality risk in the PAP group compared to the nonprophylactic group (HR = 0.615, P = 0.021). Conclusions: The practical research we conducted revealed that PAP independently safeguards against IFD in ALL patients undergoing induction therapy. Furthermore, caspofungin's safety record for treating PAP in ALL patients is positive.