Voriconazole as Secondary Prophylaxis for Leukemic Patients with Previous Invasive Fungal Diseases and Going to a New At-Risk Phase.

C. CORDONNIER1, C. PAUTAS1, J. BASTIE2, S. CASTAIGNE2, S. MAURY1, S. BRETAGNE1, P. RIBAUD3

Author address: 

1 Henri Mondor Hospital, Creteil, France, 2 Andre Mignot Hospital, Versailles, France, 3 Saint-Louis Hospital, Paris, France

Abstract: 

Background: Previous invasive fungal disease may have a major impact on the prognosis of leukemic patients when they need consolidation courses or stem cell transplants (SCT). During such at-risk periods, the risk of fungal relapse is estimated to be 30-50%, due to a new neutropenic phase, or immunosuppressive treatment (Offner et al.1998). Although it is generally accepted that these patients should benefit from a secondary prophylaxis, there is no consensus on the drug providing the best protective effect from fungal relapse. Methods: 11 patients with acute leukemia and previous invasive fungal disease, and refered for allogeneic SCT (n=9) or consolidation treatment (n=2), received voriconazole (400mg/d) as secondary prophylaxis of fungal relapse for 2 to 9 months. They had a previous history of aspergillosis (n= 10) or hepatosplenic candidiasis (n=1), with lung (n=7), ENT (n=3) or skin (n=1) involvement. All had received other antifungal drugs, mainly polyenes (n=10), as first line treatment. The fungal disease was in complete (n=6) or partial (n=5) remission when secondary prophylaxis was started, a median of 10 months after the initial fungal episode. Six received a total body irradiation. The neutropenic phase lasted 17 to 29 days. 7/9 SCT patients received steroids for graft-versus-host disease (GVHD). Results: None of the 11 patients experienced fungal relapse or new fungal disease. Two patients died without fungal disease from GVHD or leukemic relapse. The other 9 patients are alive without fungal disease, 2 to 13 months after transplant or consolidation. Conclusion: Although our series is limited, the absence of fungal relapse in a cohort of high-risk patients including 9 transplant recipients is very encouraging for the use of voriconazole for secondary prophylaxis. A larger, controlled study is warranted
2002

abstract No: 

M-894

Full conference title: 

42nd ICAAC, American Society for Microbiology, September 27 - 30, 2002, San Diego, CA
    • ICAAC 42nd