Antifungal Agents for Secondary Prophylaxis Based on Response to Initial Antifungal Therapy in Allogeneic Hematopoietic Stem Cell Transplant Recipients with Prior Pulmonary Aspergillosis |
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Institution: | 1. Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China;2. Department of Hematology, Guangzhou General Hospital of Guangzhou Command, Guangzhou, China;3. Department of Hematology, SUN Yat-sen Memorial Hospital, SUN Yat-sen University, Guangzhou, China |
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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. |
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Keywords: | Antifungal prophylaxis Invasive pulmonary aspergillosis Allogeneic hematopoietic stem cell transplantation |
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