Antifungal prophylaxis in high-risk patients with hematologic malignancy:a comparison of practice with guidelines in Türkiye

Abstract

Background/aim: Primary antifungal prophylaxis (AFP) is recommended by guidelines as the gold standard for patients with hematologic malignancies. This study aimed to investigate the level of knowledge and translation of guideline recommendations into real-life setting among physicians in Türkiye.Materials and methods: In this prospective, observational study, the physicians’ knowledge of ΑFP guideline recommendations in patients with acute myeloid leukaemia (AML) or myelodysplastic syndrome (MDS) undergoing first remission-induction (Group I), and graft-versus-host-disease (GvHD) after allogeneic stem cell transplant (Group II), was compared with clinical practice via 11-item multiple-choice questionnaire evaluating the timing and patients in whom AFP was initiated, with AFP duration and drugs used.Results: The mean age was 48.3 years and 79% had AML/MDS. AFP was initiated in 75.3% of Group I patients on the first day of induction chemotherapy before baseline and in 26.2% of Group II patients at baseline. In 98.8% of AML/MDS patients, AFP was planned to be continued until recovery from neutropenia and complete remission, whereas during immunosuppression in Group II. The median (IQR) duration of AFP was 0.8 (0.5 - 1.9) and 5.5 (2.4 - 8.1) months in Group I and II, respectively. Breakthrough invasive fungal infections (bIFIs) were observed in 35.8% and 14.3% of Group I and II, respectively.The mean survey scores were 8.5 ± 2.3 points in AML/MDS, and 9.9 ± 3.2 in GvHD patient groups. Most of the sites adhered to European Conference on Infections in Leukemia (ECIL) Guideline (80.6%), followed by Infectious Diseases Society of America, Fever and Neutropenia Guideline (IDSA) recommendations (51.6%). Posaconazole was the drug of choice in both groups (96.8% in Group I vs. 71% in Groups II).Conclusion: The data indicate an inconsistency between real-life clinical practice and guideline recommendations for primary AFP and bIFI management in high-risk patients with hematologic malignancies in Türkiye.