DP035 | THE ROLE OF ANTIFUNGAL PROPHYLAXIS IN ELDERLY ACUTE MYELOID LEUKEMIA PATIENTS UNDERGOING CONSOLIDATION CHEMOTHERAPY. A SEIFEM PROSPECTIVE, MULTICENTER STUDY

Background. The SEIFEM2016 study showed significant mortality from invasive fungal infection (IFI) in elderly patients (pts) with acute myeloid leukemia (AML) undergoing consolidation course (CC). To address the role of antifungal prophylaxis (AF) in this population, we conducted a multicenter, prospective study on behalf of the SEIFEM (Sorveglianza Epidemiologica delle InFezioni nelle EMopatie) group. Aims 1) to evaluate the incidence of IFI with or without AF, according to center’s policy, 2) to assess the incidence of breakthrough infections (BI), the overall mortality and mortality attributable to IFI. Methods. We consecutively enrolled all pts aged 60 years (y) or older undergoing CC with intermediate/high doses of cytarabine. Exclusion criteria was an IFI during induction. We collected data from 19 hematologic centers, and for each pt, all CC were documented. Results. We enrolled 175 pts for a total of 294 CC. Median age was 66 y (range 60-79) and M/F ratio 98/77. The median of CC was 1(1-4): 91 pts (52%) received 1 course, 56 (32%) 2, 12 (21%) 3 and 7 (4%) 4 courses. During CC, 129 (74%) pts underwent AF and 84 (86%) of these received anti-mold AF, mainly posaconazole [45 (54%)]. The mean duration of AF was 20.4 days (DS 16.5). Twenty-four pts (8%) developed IFI: 9 (38%) possible and 15 (62%) probable/proven(p/p), proven cases were 3 (2 Candida sp. and 1 Emmia Laceratis). The only factor associated with IFI was the duration of severe neutropenia lasting longer 10 days [OR=3.1 95% CI (1.28-7.48) p= .012]. No impact was observed by gender, comorbidities, steroid’s use, number of CC, AF during induction or AF during CC. BI were 8/24(33%): 4 possible and 4 p/p. First line antifungal therapy (AT) was started for all pts with IFI: caspofungin (9, 38%), amphotericin B (AmB) (7, 29%) or azoles (8, 33%). Only 3 pts required 2° line AT. Overall,3 pts (2%) died within 30 days. The 30 day-mortality attributable (MA) to IFI was 1/175 (0.6%). Considering only pts with IFI, the 30-day outcomes related to IFI were: 1/24 (4%) MA, 12 (50%) healing, 3 (12%) partial response, 8 (34%) stable disease. Conclusions. Despite widespread AF use in clinical practice, IFI still occurred in a significant proportion of elderly AML pts undergoing CC. The duration of severe neutropenia emerged as a key risk factor for IFI development. Further evaluation of antifungal strategies and management of BI is needed to reduce the morbidity and mortality in this vulnerable population.