Antifungal agents for secondary prophylaxis based on response to initial antifungal therapy in allogeneic hematopoietic stem cell transplant recipients with prior pulmonary aspergillosis.
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.
Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China. Electronic address: liuqifa628@163.com.
Qifa
Q
Liu
Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Ren
R
Lin
Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Jing
J
Sun
Department of Hematology, Guangzhou General Hospital of Guangzhou Command, Guangzhou, China.
Yang
Y
Xiao
Department of Hematology, SUN Yat-sen Memorial Hospital, SUN Yat-sen University, Guangzhou, China.
Danian
D
Nie
Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Yu
Y
Zhang
Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Fen
F
Huang
Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Zhiping
Z
Fan
Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Hongsheng
H
Zhou
Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Qianli
Q
Jiang
Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Fuhua
F
Zhang
Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Xiao
X
Zhai
Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Dan
D
Xu
Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Yongqiang
Y
Wei
Department of Hematology, Guangzhou General Hospital of Guangzhou Command, Guangzhou, China.
Jiayin
J
Song
Department of Hematology, SUN Yat-sen Memorial Hospital, SUN Yat-sen University, Guangzhou, China.
Yiqing
Y
Li
Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Ru
R
Feng
D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055732:Pulmonary Aspergillosis / Q000188:drug therapy* / Q000401:mortality; D012307:Risk Factors; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000009:adverse effects* / Q000379:methods; D014184:Transplantation, Homologous / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
D000935:Antifungal Agents
Allogeneic hematopoietic stem cell transplantation; Antifungal prophylaxis; Invasive pulmonary aspergillosis