title: Comparison of Three Distinct Prophylactic Agents Against Invasive Fungal Infections in Patients Undergoing Haplo-identical Hematopoietic Stem Cell Transplantation and Post-transplant Cyclophosphamide.
abstract: Over the past decade, invasive fungal infections (IFIs) have remained an important problem in patients undergoing allogeneic haematopoietic stem cell transplantation (Allo-HSCT). The optimal approach for prophylactic antifungal therapy has yet to bedetermined. We conducted a retrospective analysis, comparing the safety and efficacy of micafungin 50mg/day vs. fluconazole 400mg/day vs. itraconazole 200mg/day as prophylaxis for adult patients with various haematological diseases receiving haploidentical hematopoietic stem cell transplantation (haplo-HSCT) followed by high-dose cyclophosphamide (PT-Cy). Overall, 99 patients were identified: 30 patients received micafungin, 50 and 19 patients received itraconazole and fluconazole, respectively. After a median follow-up of 12 months (range: 1-51), proven or probable IFIs were reported in 3 patients (10%) in the micafungin, 5 patients in the itraconazole (10%) and 2 patients (11%) in the fluconazole group (p=0.998). Fewer patients in the micafungin group had invasive aspergillosis (1 [3%] vs. 3 [6%] in the itraconazole vs. 2 [11%] in the fluconazole group, p=0.589). Four patients (13%) in the micafungin group vs 13 (26%) patients in the itraconazole group and 10 (53%) patients in the fluconazole received empirical antifungal therapy (P = 0.19). No serious adverse events related to treatment were reported by patients, and there was no treatment discontinuation because of drug-related adverse events in both groups. The present analysis shows that micafungin did better than fluconazole in preventing invasive aspergillosis after transplant in these high-risk hematological diseases, as expected. In addition, micafungin was more effective than itraconazole in preventing all IFI episodes when also considering possible fungal infections. Future prospective studies would shed light on this issue, concerning this increasingly used transplant platform.
authors.affiliation: Unité de Transplantation et de Thérapie Cellulaire (U2T), Institut Paoli-Calmettes, Marseille, France ; Departement d'Onco-Hématologie, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Jean
authors.initials: J
authors.lastname: El-Cheikh
authors.affiliation: Humanitas cancer Centre, Milan, Rozzano, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Crocchiolo
authors.affiliation: Humanitas cancer Centre, Milan, Rozzano, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vai
authors.affiliation: Unité de Transplantation et de Thérapie Cellulaire (U2T), Institut Paoli-Calmettes, Marseille, France ; Departement d'Onco-Hématologie, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Sabine
authors.initials: S
authors.lastname: Furst
authors.affiliation: Humanitas cancer Centre, Milan, Rozzano, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Bramanti
authors.affiliation: Humanitas cancer Centre, Milan, Rozzano, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Sarina
authors.affiliation: Unité de Transplantation et de Thérapie Cellulaire (U2T), Institut Paoli-Calmettes, Marseille, France ; Departement d'Onco-Hématologie, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Angela
authors.initials: A
authors.lastname: Granata
authors.affiliation: Unité de Transplantation et de Thérapie Cellulaire (U2T), Institut Paoli-Calmettes, Marseille, France ; Departement d'Onco-Hématologie, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Faucher
authors.affiliation: Unité de Transplantation et de Thérapie Cellulaire (U2T), Institut Paoli-Calmettes, Marseille, France ; Departement d'Onco-Hématologie, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Bilal
authors.initials: B
authors.lastname: Mohty
authors.affiliation: Unité de Transplantation et de Thérapie Cellulaire (U2T), Institut Paoli-Calmettes, Marseille, France ; Departement d'Onco-Hématologie, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Samia
authors.initials: S
authors.lastname: Harbi
authors.affiliation: Departement d'Onco-Hématologie, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Reda
authors.initials: R
authors.lastname: Bouabdallah
authors.affiliation: Departement d'Onco-Hématologie, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Norbert
authors.initials: N
authors.lastname: Vey
authors.affiliation: Humanitas cancer Centre, Milan, Rozzano, Italy.
authors.forename: Armando
authors.initials: A
authors.lastname: Santoro
authors.affiliation: Centre de Thérapie Cellulaire, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Chabannon
authors.affiliation: Unité de Transplantation et de Thérapie Cellulaire (U2T), Institut Paoli-Calmettes, Marseille, France ; Humanitas cancer Centre, Milan, Rozzano, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Castagna
authors.affiliation: Unité de Transplantation et de Thérapie Cellulaire (U2T), Institut Paoli-Calmettes, Marseille, France ; Departement d'Onco-Hématologie, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise