Allogeneic stem cell transplantation in patients with acute myeloid leukaemia and history of invasive aspergillosis – the role of secondary prophylaxis with voriconazole: single-centre experience

Ref ID: 18556

Author:

M. Karas, K. Steinerová, T. Svoboda, S. Vokurka, P. Jindra,
V. Koza

Author address:

Charles University Hospital Pilsen (Pilsen, CZ)

Full conference title:

Annual Meeting of the EBMT, 38th

Abstract:

Background: Allogeneic stem cell transplantation (aloSCT) can
improve outcome of patients (pts) with acute myeloid leukemia
(AML). The part of pts with AML can suffer from invasive aspergillosis (IA) during remission induction treatment. These pts as
potential candidates for aloSCT have higher risk of IA relapse
and accompanying higher morbidity and mortality after aloSCT.
Several published studies indicate that secondary prophylaxis
with potent antifungal agents could decrease risk of IA relapse
after aloSCT. To evaluate the role of secondary prophylaxis with
voriconazole in pts with history of IA who undergo aloSCT for
AML we retrospectively analysed outcome of such pts transplanted at our centre.
Patients and Methods: in period 1/2005-10/2011, 21 pts with
AML (71% in 1.CR, 29% beyond 1.CR) and history of IA (38%
with residual infi ltrates) underwent aloSCT (81% redecudintensity, 19% myeloablative aloSCT). The donor was in 29%
HLA identical related, in 38% matched and in 33% mismatched unrelated. Source of stem cells was peripheral blood and
the median of infused CD 34+cells was 5,2×10
6
/kg (range:
1,7-14,9×10
6
/kg). CsA and methotrexate were administered as
GVHD prophylaxis. Voriconazole (200mg twice daily) was used
as invasive fungal infection (IFI) prophylaxis from day -1. Other
antimicrobial prophylaxis included norfl oxacin and aciclovir.
Evaluation and treatment of aloSCT complications and
outcome was made according to established criteria and
recommendation.
Results: All pts fully engrafted and achieved CR. 7 pts (33%)
developed aGVHD (5% grade III-IV) and among 18 evaluable
pts 10 (56%) of them developed chGVHD (50% extensive). With
median follow-up 23 months (range, 2-64 months) 13 pts (62%)
are alive in CR. 2 pts (10%) relapsed and died. 6 pts (28%)
died due to NRM and 2 (10%) of them till day 100. The median
time of voriconazole administration was 60 days (range, 21-131
days) and only in 1 patient (5%) voriconazole was stopped due
to hepatic toxicity. With above mentioned follow-up only 2 pts
(10%) developed IFI (1 case with IFI-related death). The estimated probabilities of 3-years EFS and OS are 52%.
Conclusion: In spite of relatively small number of analysed pts
and retrospective type of analysis, our data suggest and also
support results of previous published studies that secondary
prophylaxis with voriconazole in pts with AML and history of IA
undergoing aloSCT is well tolerated and can protect these pts
from higher risk of IA relapse.

Abstract Number: P485

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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