Background: Recurrence of prior invasive fungal infection (relapse rate 30-50%) limits the success of stem cell transplantation. Secondary prophylaxis against invasive aspergillosis involves the administration of antifungal drugs to patiens who are undergoing a period of immunosuppression and who have a history of invasive aspergillosis. Design and methods: Our study was conducted evaluating voriconazole (4 mg/kg/12 h intravenously or 200 mg/12 h orally) as secondary antifungal prophylaxis in autologous stem cell transplant recipients with previous proven or problable invasive fungal infection. Voriconazole was started 48 h or more after completion of condicioning chemotherapy and was planned to be continued for 40 days. Patients were followed for 12 months for incidence of proven or problable invasive fungal infections. Results: Twenty-eight patiens were enrolled, 19 of whom had stem cell transplant for acute leukemia. Previous invasive fungal infections were proven and probable aspergillosis (n=19), proven candidiasis (n=5) and other proven or probable infections (n=2), prior infection could not be confi rmed in two patiens. The median duration of voriconazole prophylaxis was 28 days.Two patiens (7%) died within 12 months of transplantation, but only one due to systemic fungal disease. Only 2 invasive fungal infections occured post-transplant: two relapses (one candidemia and combination of aspergillosis plus candidosis in 1 patient) .In one patient the prophylaxis was interrupted due to treatment related adverse events. Conclusions: Voriconazole appear to be safe and effective for secondary prophylaxis of systemic fungal infection after highdose chemotherapy and autologous stem cell transplantation. Treatment-related adverse events were acceptable and consistent with clinical experiences in this high- risk population. Thus, voriconazole may be a promising agent in adults undergoing SCT for a hematologic disease.
Full conference title:
Annual Meeting of the EBMT, 37th
- EBMT 37th (2011)