Antifungal prophylaxis with posaconazole in different risk-groups of allograft recipients

Ref ID: 18591

Author:

J. Sinko, L. Lengyel, A. Barta, E. Torbagyi, L. Gopcsa, A. Batai,
Z. Csukly, R. Nikolova, A. Varkonyi, P. Remenyi, T. Masszi

Author address:

St. Istvan & St Laszlo Hospital (Budapest, HU)

Full conference title:

Annual Meeting of the EBMT, 36th

Abstract:

Background: Posaconazole (POSA) is registered for moldactive antifungal prophylaxis in neutropenic patients with acute
myeloid leukemia/myelodysplastic syndrome and for allogeneic
hematopoietic stem cell transplant (allo-HSCT) recipients with
graft-versus-host disease (GvHD).
Methods: In our single-center observational survey a total of
36 allo-HSCT recipients were given POSA prophylaxis and
evaluated for clinical effi cacy. In 17 patients a myeloablative, in further 19 reduced intensity conditioning regimen was
used. Grafts from HLA identical sibling donors were transplanted in 19 and from matched unrelated donors (MUD) in
17 cases. In subgroup A) POSA was given during the neutropenic phase and stopped at engraftment in cases with no
GvHD (11 patients). In subgroup B) prophylaxis was also
started with neutropenia but carried on during the subsequent
period of acute GvHD and immunosuppression (16 patients).
In subgroup C) POSA was started post engraftment in cases
of severe GvHD (9 patients). On the basis of fungal history
prophylaxis was classifi ed as being primary (31 patients) or
secondary (5 patients). The median duration of prophylaxis
was 81 (11-311) days. Patients were followed for median 275
days (21-481). Success was defi ned as absence of invasive
fungal disease (IFD) at the end of the observation in patients
on POSA. Success with modifi cation was used for cases
receiving empirical antifungal therapy following POSA. All
patients developing proven or probable IFD were regarded
as failures.
Results: At the end of the follow-up period POSA prophylaxis
was successful in 29 patients (81%). Success with modifi cation was registered in 3(8%) and failure in 4 cases (11%). Subgroups: A). Success: 10/11, success with modifi cation: 0/11,
failure: 1/11. B). Success: 12/16, success with modifi cation:
2/16, failure: 2/16. C).
Success: 7/9, success with modifi cation: 1/9, failure: 1/9.
Failures: 1. Male (36 y), MUD, grade 4 intestinal GvHD, disseminated Aspergillus and Rhisopus infection, died. 2. Female
(24 y) sibling donor, grade 3 GvHD, probable aspergillosis, survived. 3. Male (20 y), sibling donor, noncompliant, candidemia
(C. krusei), died. 4. Male (54 y), sibling donor, grade 4 intestinal
GvHD, died, on autopsy disseminated zygomycosis detected.
Conclusions: In allo-HSCT recipients POSA prophylaxis
seems to be effective for all risk groups in all risk periods.
Importance of gastrointestinal absorption and compliance
must be emphasized.

Abstract Number: P789

Conference Year: 2010

Link to conference website: NULL

New link: NULL

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