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Evaluation of Antifungal Prophylaxis in Allogeneic HCT Patients

A study on antifungal prophylaxis strategies for allogeneic hematopoietic cell transplant patients at Virginia Commonwealth University Health System. The research aims to determine the incidence and outcomes of Invasive Mold Infections in this population over a five-year period.

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Evaluation of Antifungal Prophylaxis in Allogeneic HCT Patients

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  1. Evaluation of Antifungal Prophylaxis Strategy for Allogeneic Hematopoietic Cell Transplant Patients • Leah B. Herity, PharmD, MPH • PGY1 Pharmacy Practice Resident • Virginia Commonwealth University Health System

  2. Disclosure • The authors and contributors of this project have no conflict of interest to disclose.

  3. Invasive Mold Infections (IMI)in Allogeneic Hematopoietic Cell Transplant (HCT) Patients Clin Chest Med. 2017 Dec;38(4):727-73 TransplInfect Dis. 2018;e12897 Biol Blood Marrow Transplant. 2013;19(8):11906

  4. Classification of IMI

  5. Previous Studies of Antifungal Prophylaxis RCT = randomized, controlled trial

  6. Primary Antifungal Prophylaxis Strategy at Virginia Commonwealth University (VCU) Health System • Patients may be switched to other antifungals depending on certain characteristics Post-engraftment Pre-engraftment

  7. Objective • To determine the incidence and outcomes of IMI in allogeneic HCT patients at VCU Health System receiving primary antifungal prophylaxis

  8. Methods • Retrospective medical record review • Data collected from Cerner Information Systems • January 1, 2013 through December 31, 2017 • Patients followed for 1 year post-transplant • Quality improvement project • VCU Institutional Review Board • Massey Cancer Center Protocol Review and Monitoring Committee (PRMC)

  9. Study Population

  10. Endpoints *Death within 12 weeks of IMI diagnosis

  11. Statistical Analysis • Demographics • Descriptive statistics • Primary outcome • Incidence rates • Kaplan-Meier survival estimates and log-rank tests • Secondary outcomes • Descriptive statistics • Chi-squared and Fisher’s Exact tests for risk factors • Analyses performed in Stata MP 15.1

  12. Patient Characteristics No statistically significant differences between groups

  13. Patient Characteristics *P<0.001 by chi-squared test

  14. Proven or Probable IMI Incidence Rate 33 cases per 100 patient-years

  15. Proven or Probable IMI Characteristics

  16. Proven or Probable IMI by Underlying Disease P-value = 0.44

  17. Proven or Probable IMI by Transplant Type P-value = 0.09

  18. Overall Survival P-value < 0.0001

  19. Limitations

  20. Conclusions

  21. Acknowledgments • May T. Aziz, PharmD, BCPS, BCOP • Teresa Potter, PharmD, MPH, BCPS • Oveimar A. De la Cruz, M.D.

  22. Questions? • Leah B. Herity, PharmD, MPH • leah.herity@vcuhealth.org • 804-828-6748

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