title: Initial fluconazole prophylaxis may not be required in adults with acute leukemia or myelodysplastic/myeloproliferative disorders after reduced intensity conditioning peripheral blood stem cell allogeneic transplantation.
abstract: In the myeloablative transplant setting, the early use of fluconazole prophylaxis provides a benefit in overall survival. Recent changes in transplantation practices, including the use of peripheral blood stem cells (PBSC) and/or reduced intensity conditioning (RIC) regimen may have favorably impacted the epidemiology of invasive fungal infections (IFI) after allogeneic stem cell transplantation (allo-SCT). Yet, the impact of removing fluconazole prophylaxis after RIC PBSC allotransplant is ill known. Here, a retrospective analysis was performed comparing patients who received fluconazole as antifungal prophylaxis (n = 53) or not (n = 56) after allo-SCT for acute leukemia or myelodysplastic/myeloproliferative syndrome. Sixteen IFI were documented (14 %) at a median time of 103 days after transplantation, including eight before day +100, at a similar rate, whether the patients received fluconazole prophylaxis (13 %) or not (16 %). IFI were due mainly to Aspergillus species (87 %), and only two Candida-related IFI (13 %) were documented in the non-fluconazole group before day +100. The incidences of IFI (overall, before or after day +100) as well as 3-year overall and disease-free survival, non-relapse mortality, or acute and chronic graft-versus-host disease (GVHD) were similar between both groups. In conclusion, this study suggests that fluconazole may not be required at the initial phase of RIC allo-SCT using PBSC. This result has to be confirmed prospectively while Aspergillus prophylaxis should be discussed in this particular setting.
authors.affiliation: Hematology Department and Centre d'Investigation Clinique en Cancérologie (CI2C), CHU Hotel-Dieu, Nantes, France.
authors.forename: Eolia
authors.initials: E
authors.lastname: Brissot
authors.forename: Xavier
authors.initials: X
authors.lastname: Cahu
authors.forename: Thierry
authors.initials: T
authors.lastname: Guillaume
authors.forename: Jacques
authors.initials: J
authors.lastname: Delaunay
authors.forename: Sameh
authors.initials: S
authors.lastname: Ayari
authors.forename: Pierre
authors.initials: P
authors.lastname: Peterlin
authors.forename: Amandine
authors.initials: A
authors.lastname: Le Bourgeois
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Harousseau
authors.forename: Noel
authors.initials: N
authors.lastname: Milpied
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Bene
authors.forename: Philippe
authors.initials: P
authors.lastname: Moreau
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
authors.forename: Patrice
authors.initials: P
authors.lastname: Chevallier
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D018890:Chemoprevention / Q000379:methods*; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D007938:Leukemia / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology / Q000517:prevention & control*; D009190:Myelodysplastic Syndromes / Q000453:epidemiology / Q000628:therapy*; D009196:Myeloproliferative Disorders / Q000453:epidemiology / Q000628:therapy*; D020360:Neoadjuvant Therapy; D009894:Opportunistic Infections / Q000453:epidemiology / Q000517:prevention & control; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D015725:Fluconazole