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.
Full conference title:
Annual Meeting of the EBMT, 36th
- EBMT 36th (2010)