Implementation of a Protocol for Posaconazole Prophylaxis in Patients Undergoing Remission-Induction Chemotherapy for Acute Leukemia: From Guidelines to Real-Life
Bibliographic record
Abstract
Background. Posaconazole is effective in preventing invasive fungal infections in patients undergoing chemotherapy for acute leukemia. The goal of the study was to determine the incidence of invasive aspergillosis in a center before and after the implementation of a protocol for posaconazole prophylaxis and to evaluate its real-life adherence. Methods. We reviewed the medical charts of all adult patients admitted to the hematology ward for acute leukemia between October 2011 and September 2014. During the first 18 months, anti-aspergillus preemptive therapy was used, while patients received posaconazole prophylaxis in the second 18-month period. The primary endpoint was the incidence of invasive aspergillosis. In addition, we assessed the various difficulties linked to the application of the protocol. Results. We retrieved records for 65 patients with acute leukemia for a total of 106 courses of remission-induction chemotherapy. The incidence of proven or probable invasive aspergillosis reported was 9.7% (3 patients) in the preemptive group and 4.3% (1 patient) in the prophylaxis group. However, the 5.4% decrease in incidence is not statistically significant. When including possible invasive aspergillosis, the incidence decreased from 16.1% (5 patients) without prophylaxis to 8.7% (2 patients) with posaconazole. The number needed to treat varied from 14 to 19. Before and during the implementation of the prophylaxis protocol, many strategies were used to inform doctors and medical staff. During the preemptive therapy period, physicians adhered to the protocol in only 82% of treatments, as compared to 93.2% during the prophylaxis protocol (posaconazole prescription was omitted in 2.3% and delayed in 4.5%). Of note, posaconazole prophylaxis was interrupted in 2.3% (1 patient) due to intolerance. Conclusion. We found a reduction of the incidence of invasive aspergillosis in our center with the implementation of the new protocol. Despite adequate physician adherence to the protocol, there were still cases of infections. This may be possibly explained by a lower bioavailability of the oral-suspension posaconazole or more resistant strains. A third phase of this study could focus on the introduction of posaconazole delayed-release tablet. Disclosures. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.043 | 0.080 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".