title: Primary or secondary antifungal prophylaxis in patients with hematological maligancies: efficacy and damage.
abstract: BACKGROUND
  Patients with hematological malignancies often develop febrile neutropenia (FN) as a complication of cancer chemotherapy. Primary or secondary antifungal prophylaxis is recommended for patients with hematological malignancies to reduce the risk of invasive fungal infection (IFI). This study retrospectively evaluated the efficacy and potential harm of administration of primary and secondary antifungal prophylaxis to patients with hematological malignancies at one hospital.
  
  
  METHODS
  All patients with hematological malignancies older than 14 years of age who had experienced at least one FN attack during chemotherapy while being treated at one hospital between November 2010 and November 2012 were retrospectively evaluated.
  
  
  RESULTS
  A total of 282 FN episodes in 126 consecutive patients were examined during a 2-year study period. The mean patient age was 51.73±14.4 years (range: 17-82 years), and 66 patients were male. Primary prophylaxis with posaconazole was administered to 13 patients and systemic antifungal treatment under induction or consolidation chemotherapy to seven patients. Of 26 patients who received secondary antifungal prophylaxis with either oral voriconazole (n=17) or posaconazole (n=6) during 46 FN episodes, systemic antifungal therapy was administered in 16 of 38 episodes and three of eight episodes, respectively. Secondary antifungal prophylaxis with caspofungin was found effective in treating six FN episodes in three patients who had experienced at least two persistent candidemia attacks. The mortality rates associated with IFI were 9% in the first year, 2% in the second year, and 6% overall. The mortality rates associated with candidemia were 33% in the first year, 22% in the second year, and 27% overall.
  
  
  CONCLUSIONS
  Primary antifungal prophylaxis should be administered to selected patients on the basis of consideration of efficacy, cost, and potential harm. Use of secondary prophylaxis may reduce systemic antifungal use and IFI frequency but may increase risk of colonization and infection with azole-resistant fungal strains.
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Habip
authors.initials: H
authors.lastname: Gedik
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Funda
authors.initials: F
authors.lastname: Simşek
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Taner
authors.initials: T
authors.lastname: Yıldırmak
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Arzu
authors.initials: A
authors.lastname: Kantürk
authors.affiliation: Department of Hematology, Ministry of Health Okmeydanı Training and Research Hospital, Istanbul, Turkey.
authors.forename: Deniz
authors.initials: D
authors.lastname: Arıca
authors.affiliation: Department of Hematology, Ministry of Health Okmeydanı Training and Research Hospital, Istanbul, Turkey.
authors.forename: Demet
authors.initials: D
authors.lastname: Aydın
authors.affiliation: Department of Hematology, Ministry of Health Okmeydanı Training and Research Hospital, Istanbul, Turkey.
authors.forename: Naciye
authors.initials: N
authors.lastname: Demirel
authors.affiliation: Department of Hematology, Ministry of Health Okmeydanı Training and Research Hospital, Istanbul, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Yokuş
keywords: azole resistance; febrile neutropenia; hematological malignancy; invasive fungal infection; primary antifungal prophylaxis; secondary antifungal prophylaxis