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 5,2x10 6 /kg (range: 1,7-14,9x10 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.
Full conference title:
Annual Meeting of the EBMT, 38th
- EBMT 38th (2012)