Journal
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
Volume 20, Issue 8, Pages 1198-1203Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.bbmt.2014.04.016
Keywords
Antifungal prophylaxis; Invasive pulmonary aspergillosis; Allogeneic hematopoietic stem cell transplantation
Categories
Funding
- National High Technology Research and Development Program of China (863 Program) [2011AA020105]
- National Public Health Grand Research Foundation [201202017]
- National Natural Science Foundation of China [81000231, 81270647, 30971300]
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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. (C) 2014 American Society for Blood and Marrow Transplantation.
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