Among children, adolescents and young adults with acute myeloid leukaemia (AML), prophylaxis with caspofungin results in significantly lower incidence of invasive fungal disease, compared with fluconazole, according to research published in JAMA.
The multicentre, randomised, open-label, clinical trial included 517 participants aged three months to 30 years with newly diagnosed de novo, relapsed or secondary AML. Prophylaxis was administered during the neutropenic period following each chemotherapy cycle.
A previous interim analysis based on 394 patients appeared to suggest futility with caspofungin, so the study was closed to accrual.
However, among 508 people who completed the trial (last follow-up June 30, 2018), five-month cumulative incidence of proven or probable invasive fungal disease was 3.1 per cent with caspofungin vs 7.2 per cent with fluconazole. Cumulative incidence of proven or probable invasive aspergillosis was 0.5 vs 3.1 per cent, respectively.
No significant differences in empirical antifungal therapy or two-year overall survival were observed.
The most common toxicities were hypokalaemia, respiratory failure and elevated alanine transaminase (ALT).
The authors said the findings suggest that caspofungin may be considered for prophylaxis against invasive fungal disease; however, they pointed out that study interpretation is limited by early termination.