Randomized, double-blind trial of fluconazole versus voriconazole for prevention of invasive fungal infection after allogeneic hematopoietic cell transplantation.
Invasive fungal infection (IFI) is a serious threat after allogeneic hematopoietic cell transplant (HCT). This multicenter, randomized, double-blind trial compared fluconazole (N = 295) versus voriconazole (N = 305) for the prevention of IFI in the context of a structured fungal screening program. Patients undergoing myeloablative allogeneic HCT were randomized before HCT to receive study drugs for 100 days, or for 180 days in higher-risk patients. Serum galactomannan was assayed twice weekly for 60 days, then at least weekly until day 100. Positive galactomannan or suggestive signs triggered mandatory evaluation for IFI. The primary endpoint was freedom from IFI or death (fungal-free survival; FFS) at 180 days. Despite trends to fewer IFIs (7.3% vs 11.2%; P = .12), Aspergillus infections (9 vs 17; P = .09), and less frequent empiric antifungal therapy (24.1% vs 30.2%, P = .11) with voriconazole, FFS rates (75% vs 78%; P = .49) at 180 days were similar with fluconazole and voriconazole, respectively. Relapse-free and overall survival and the incidence of severe adverse events were also similar. This study demonstrates that in the context of intensive monitoring and structured empiric antifungal therapy, 6-month FFS and overall survival did not differ in allogeneic HCT recipients given prophylactic fluconazole or voriconazole. This trial was registered at www.clinicaltrials.gov as NCT00075803.
Wingard
John R
JR
University of Florida, Gainesville, FL, USA. wingajr@medicine.ufl.edu
Carter
Shelly L
SL
Walsh
Thomas J
TJ
Kurtzberg
Joanne
J
Small
Trudy N
TN
Baden
Lindsey R
LR
Gersten
Iris D
ID
Mendizabal
Adam M
AM
Leather
Helen L
HL
Confer
Dennis L
DL
Maziarz
Richard T
RT
Stadtmauer
Edward A
EA
Bolaños-Meade
Javier
J
Brown
Janice
J
Dipersio
John F
JF
Boeckh
Michael
M
Marr
Kieren A
KA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents; D001228:Aspergillosis / Q000188:drug therapy / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D004311:Double-Blind Method; D016903:Drug Monitoring; D015725:Fluconazole / Q000008:administration & dosage* / Q000009:adverse effects; D005690:Galactose / Q000031:analogs & derivatives; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008351:Mannans / Q000097:blood; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000517:prevention & control*; D019653:Myeloablative Agonists / Q000627:therapeutic use; D015996:Survival Rate; D014184:Transplantation, Homologous; D055815:Young Adult
D000935:Antifungal Agents; D008351:Mannans; D019653:Myeloablative Agonists; C012990:galactomannan; D015725:Fluconazole; D005690:Galactose
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