Posaconazole primary prophylaxis in HSCT recipients

Ref ID: 18588

Author:

L. Cameron, M. Streetly, M. Kazmi, K. Raj

Author address:

Guy’s Hospital (London, UK)

Full conference title:

Annual Meeting of the EBMT, 36th

Abstract:

Background: The data for posaconazole (POS) as primary
prophylaxis for invasive fungal infection (IFI) is limited. There
are two published studies; Ullmann et al. reported that POS
was as effective as fl uconazole in preventing IFI in patients with
graft versus host disease (GVHD) following allogeneic stem
cell transplant (SCT). In neutropenic patients following chemotherapy for AML/MDS, Cornely et al. found POS to be superior
to fl uconazole/itraconazole in preventing IFI. Based on these
large, randomised studies, POS has been adopted by our centre as primary antifungal prophylaxis. We describe our experience with POS which is predominantly in haematopoietic SCT
(HSCT) recipients.
Methods: Retrospective analysis of adult patients who received
POS prophylaxis between January 2007 and December 2009.
Evidence of breakthrough IFI was recorded as per EORTC/
MSG defi nitions. Liver function tests (LFTs) prior to initiating,
during and after treatment with POS were reviewed. Events
that could contribute to LFT derangement were identifi ed from
the medical notes.
Results: 59 patients received POS prophylaxis (n = 52 primary,
n = 7 secondary). Of these, 52 were undergoing HSCT (n = 32
reduced intensity conditioning allograft, n = 10 full intensity allograft, n = 4 autograft including total-body-irradiation or T-cell
depletion, n = 2 umbilical cord transplant, n = 4 haploidentical
transplant) and 7 were undergoing intensive chemotherapy for
the treatment of leukaemia.
6 patients developed an IFI, classifi ed as per EORTC/MSG
defi nitions proven (n = 1), probable (n = 2), possible (n = 3). Of
these, 3 patients had gut GVHD and 3 were undergoing intensive chemotherapy for the treatment of AML.
The causative organisms identifi ed in the proven and probable
cases were Candida glabrata (n = 1) and Aspergillus spp (n = 2).
LFTs deteriorated in 23 patients on POS (n = 7 abnormal LFTS
pre POS, n = 16 normal LFTs pre POS) and the cause was con-
fi dently attributed to GVHD (n = 7), sepsis (n = 5), viral reactivation (n = 5), other drugs (n = 5) and disease relapse (n = 1).
Conclusions: Primary prophylaxis was effective with 10% breakthrough. This occurred particularly in patients with gut GVHD.
Therefore we suggest that an alternative be used. POS can be
used safely in patients with deranged LFTs as an alternative to
conventional antifungal therapies. This is particularly important
following HSCT where the incidence of abnormal LFTs secondary to sepsis, drug toxicity, viral infection (CMV, EBV) and
GVHD is high.

Abstract Number: P783

Conference Year: 2010

Link to conference website: NULL

New link: NULL

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