Background:Invasive fungal infections (IFIs) are a major complication in patients with acute myeloid leukemia (AML), particularly during chemotherapy-induced neutropenia. Posaconazole is the standard drug for primary antifungal prophylaxis (PAP), but its use is limited by oral bioavailability and CYP3A4 interactions.Study Objective:This study aims to evaluate the clinical efficacy and safety of intravenous caspofungin versus oral posaconazole as PAP in AML patients during their first cycle of chemotherapy and assess their subsequent impact on clinical outcomes.Methods:A retrospective, monocentric study was conducted on 75 consecutive AML patients treated at the Federico II University Medical School of Naples, Italy (2021–2025). Patients received either caspofungin or posaconazole as PAP based on the drug–drug interaction risk or clinical conditions. IFIs were diagnosed using EORTC/MSG criteria. Logistic and Cox regression models were used to assess risk factors and overall survival (OS).Results:IFI incidence was 13.3% overall (9.4% proven/probable). No significant difference was found between the caspofungin and posaconazole groups (six vs. four IFIs;p= 0.878). Post-chemotherapy refractory AML (OR = 11.9;p= 0.003) and liver disease (OR = 30.4;p= 0.004) independently predicted IFI development. Median OS did not significantly differ in patients receiving caspofungin versus posaconazole (29.3 vs. 32.1 months,p= 0.6).Conclusions:Caspofungin appears clinically comparable to posaconazole for PAP in AML during the induction phase, especially when azole use is contraindicated. Prospective studies are warranted to refine prophylactic strategies in the era of new AML therapies.
背景：侵袭性真菌感染（IFI）是急性髓系白血病（AML）患者的主要并发症，尤其在化疗导致的中性粒细胞减少期间。泊沙康唑是初级抗真菌预防（PAP）的标准药物，但其应用受限于口服生物利用度及CYP3A4相互作用。 研究目的：本研究旨在评估静脉注射卡泊芬净与口服泊沙康唑作为AML患者首个化疗周期PAP的临床疗效与安全性，并分析其对后续临床结局的影响。 方法：本研究对意大利那不勒斯费德里科二世大学医学院（2021–2025年）连续收治的75例AML患者进行回顾性单中心分析。根据药物相互作用风险或临床状况，患者接受卡泊芬净或泊沙康唑作为PAP。IFI诊断依据EORTC/MSG标准。采用Logistic回归和Cox回归模型评估危险因素及总生存期（OS）。 结果：总体IFI发生率为13.3%（确诊/临床诊断占9.4%）。卡泊芬净组与泊沙康唑组间无显著差异（6例 vs. 4例；p=0.878）。化疗后难治性AML（OR=11.9；p=0.003）与肝脏疾病（OR=30.4；p=0.004）是IFI发生的独立预测因素。卡泊芬净组与泊沙康唑组患者的中位OS无显著差异（29.3个月 vs. 32.1个月，p=0.6）。 结论：在AML诱导治疗阶段，卡泊芬净作为PAP的临床效果与泊沙康唑相当，尤其适用于唑类药物禁忌的情况。未来需开展前瞻性研究，以优化新型AML治疗时代的预防策略。
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