Antifungal agents for secondary prophylaxis based on response to initial antifungal therapy in allogeneic hematopoietic stem cell transplant recipients with prior pulmonary aspergillosis.

Abstract

We performed a prospective study to evaluate the efficacy and safety of secondary antifungal prophylaxis (SAP) for patients with a history of invasive pulmonary aspergillosis (IPA) in allogeneic hematopoietic stem cell transplantation (allo-HSCT). In this study, the prophylactic agents used were chosen based on treatment response to initial antifungal therapy. One hundred and thirty-six patients undergoing allo-HSCT with prior IPA were enrolled in this multicenter study. The agents of SAP included itraconazole in 24, voriconazole in 74, caspofungin in 32, and liposomal amphotericin B in 6. Eighty-eight patients had stable IPA and 48 had active IPA at the time of transplantation. The success rate of SAP was 91.2%. Twelve patients developed breakthrough invasive fungal disease (IFD), and none discontinued antifungal agents because drug-related adverse events. The incidence of breakthrough IFD was neither different among the different antifungal agents (P = .675) nor between patients with active and stable IPA (P = .080). The 1-year cumulative incidence of IFD and IPA relapse was 27.3% ± 4.5% and 24.7% ± 4.4%, respectively. Our data indicate that SAP with antifungal agents based on initial antifungal therapy has favorable efficacy and safety in allo-HSCT recipients with prior IPA. Active IPA might not increase the risk of breakthrough IFD after transplantation.

• Authors: Qifa Liu, Ren Lin, Jing Sun, Yang Xiao, Danian Nie, Yu Zhang, Fen Huang, Zhiping Fan, Hongsheng Zhou, Qianli Jiang, Fuhua Zhang, Xiao Zhai, Dan Xu, Yongqiang Wei, Jiayin Song, Yiqing Li, Ru Feng
• Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 20 Issue 8 Pg. 1198-203 (Aug 2014) ISSN: 1523-6536 [Electronic] United States
• PMID: 24769013 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antifungal Agents

Topics

• Adolescent
• Adult
• Antifungal Agents (therapeutic use)
• Female
• Hematopoietic Stem Cell Transplantation (adverse effects, methods)
• Humans
• Male
• Middle Aged
• Prospective Studies
• Pulmonary Aspergillosis (drug therapy, mortality)
• Risk Factors
• Survival Analysis
• Transplantation Conditioning (adverse effects, methods)
• Transplantation, Homologous (adverse effects, methods)
• Treatment Outcome
• Young Adult