Clinical evaluation of secondary posaconazole prophylaxis in the initial neutropenic phase of allo-HSCT: a small case series from a single unit

Agnieszka Tomaszewska*, Barbara Nasilowska-Adamska, Andrzej Szczepinski, Bozena Marianska

Author address: 

Warsaw, PL

Abstract: 

Introduction: Invasive fungal diseases (IFDs) are life-threatening complications of allogeneic haematopoietic stem cell transplant (alloHSCT) procedures, especially in patients with previous history of invasive aspergillosis or candidiasis. There is no standard approach for secondary prophylaxis in this setting of patients. We report 7 cases of posaconazole prophylaxis during neutropenic phase of alloHSCT in patients with IFD history, mostly invasive pulmonary aspergillosis. 
Materials and methods: We evaluated clinical results of posaconazole secondary prophylaxis in 7 patients with acute leukaemias (2-lymphoblastic, 5-myelogenous; 3 females and 4 males; median age 49; range 24–55) undergoing alloHSCT. The donors were HLA-identical siblings (1) or unrelated (6). Peripheral blood stem cells mobilized with G-CSF were used. Conditioning regimens were myeloablative in 6 patients and of reduced intensity in 1. Besides in 6 cases in vivo T-depletion with thymoglobuline was performed. All patients presented with IFD during remission-induction or consolidation chemotherapy: 6-invasive aspergillosis, 1-invasive candidiasis and aspergillosis. Patient were treated with various antifungals: amphotericin B, casposfungin, voriconazole and posaconazole. Two of them underwent lung lobectomy due to aspergilloma. The prophylaxis with oral posaconazole at the dose of 200 mg three times daily was started in every patient directly from the conditioning regimen beginning and was continued to full hematologic recovery and/or immunosuppression discontinuation. 
Results: 6 patients (85,7%) are alive at 7–32 months after transplantation and none of them developed IFD after alloHSCT. One patient died on +23 day after transplant, without hematologic recovery, due to Stenotrophomonas maltophila sepsis and fungal pneumonia suspicion (not proven). No side effects of posaconazole therapy was observed. 
Conclusions: Our observational report indicates that secondary prophylaxis with oral posaconazole is safe and effective in high risk of mould infection reactivation group of patients during alloHSCT procedures. These findings confirmed some previously published data, but should be studied prospectively and in the larger group of patients.

2013

Full conference title: 

Annual Meeting of European Society for Blood and Marrow Transplantation
    • EBMT 39th (2013)