Clinical efficacy and safety of primary antifungal prophylaxis with posaconazole versus fluconazole in allogeneic blood hematopoietic stem cell transplantation recipients-A retrospective analysis of a single medical center in Taiwan

Ching Hsun Wang, Li Ping Kan, Hsin An Lin, Feng Yee Chang, Ning Chi Wang, Te Yu Lin, Tsu Yi Chao, Woei Yau Kao, Ching Liang Ho, Yeu Chin Chen, Ming Shen Dai, Ping Ying Chang, Yi Ying Wu, Jung Chung Lin

Research output: Contribution to journalArticle

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Abstract

Background/Purpose: The efficacy and safety of posaconazole compared to fluconazole as antifungal prophylaxis in patients receiving allogeneic blood hematopoietic stem cell transplantation (allo-HSCT) during the early neutropenic phase without graft-versus-host disease (GVHD) was uncertain. Methods: The medical records of allo-HSCT recipients from a single institution, who received oral fluconazole (from January 2005 to June 2011) or oral posaconazole (from June 2011 to December 2013) during the early neutropenic phase (until engraftment), were retrospectively reviewed. Results: There were 52 allo-HSCT recipients, two of whom were younger than 18 years of age. Twelve cases received posaconazole and 40 cases received fluconazole as primary antifungal prophylaxis. The two groups had similar transplant characteristics, conditioning, and GVHD prophylaxis regimens. The fluconazole group had a higher risk for development of invasive fungal infections within 90 days after allo-HSCT (43% vs. 8.3%, p = 0.039). Kaplan-Meier analysis indicated that the cumulative incidence of invasive fungal infection for 90 days after allo-HSCT was higher in the fluconazole group (log rank test, p = 0.047). Early discontinuation of antifungal prophylaxis for intolerance was significantly lower in the posaconazole group (8.3% vs. 50%, p = 0.017). Both groups had similar rates of impaired liver function. Conclusion: Analysis of primary fungal prophylaxis during the early neutropenic phase following allo-HSCT indicated that posaconazole was more effective and was better tolerated than fluconazole. Both drugs had similar safety profiles.

Original languageEnglish
JournalJournal of Microbiology, Immunology and Infection
DOIs
Publication statusAccepted/In press - Apr 28 2014

Fingerprint

Fluconazole
Hematopoietic Stem Cell Transplantation
Taiwan
Safety
Graft vs Host Disease
Kaplan-Meier Estimate
Medical Records
posaconazole
Transplants
Liver
Incidence
Pharmaceutical Preparations

Keywords

  • Fluconazole
  • Posaconazole
  • Prophylaxis
  • Transplantation

ASJC Scopus subject areas

  • Microbiology (medical)
  • Immunology and Allergy
  • Immunology and Microbiology(all)
  • Infectious Diseases

Cite this

Clinical efficacy and safety of primary antifungal prophylaxis with posaconazole versus fluconazole in allogeneic blood hematopoietic stem cell transplantation recipients-A retrospective analysis of a single medical center in Taiwan. / Wang, Ching Hsun; Kan, Li Ping; Lin, Hsin An; Chang, Feng Yee; Wang, Ning Chi; Lin, Te Yu; Chao, Tsu Yi; Kao, Woei Yau; Ho, Ching Liang; Chen, Yeu Chin; Dai, Ming Shen; Chang, Ping Ying; Wu, Yi Ying; Lin, Jung Chung.

In: Journal of Microbiology, Immunology and Infection, 28.04.2014.

Research output: Contribution to journalArticle

Wang, Ching Hsun ; Kan, Li Ping ; Lin, Hsin An ; Chang, Feng Yee ; Wang, Ning Chi ; Lin, Te Yu ; Chao, Tsu Yi ; Kao, Woei Yau ; Ho, Ching Liang ; Chen, Yeu Chin ; Dai, Ming Shen ; Chang, Ping Ying ; Wu, Yi Ying ; Lin, Jung Chung. / Clinical efficacy and safety of primary antifungal prophylaxis with posaconazole versus fluconazole in allogeneic blood hematopoietic stem cell transplantation recipients-A retrospective analysis of a single medical center in Taiwan. In: Journal of Microbiology, Immunology and Infection. 2014.
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abstract = "Background/Purpose: The efficacy and safety of posaconazole compared to fluconazole as antifungal prophylaxis in patients receiving allogeneic blood hematopoietic stem cell transplantation (allo-HSCT) during the early neutropenic phase without graft-versus-host disease (GVHD) was uncertain. Methods: The medical records of allo-HSCT recipients from a single institution, who received oral fluconazole (from January 2005 to June 2011) or oral posaconazole (from June 2011 to December 2013) during the early neutropenic phase (until engraftment), were retrospectively reviewed. Results: There were 52 allo-HSCT recipients, two of whom were younger than 18 years of age. Twelve cases received posaconazole and 40 cases received fluconazole as primary antifungal prophylaxis. The two groups had similar transplant characteristics, conditioning, and GVHD prophylaxis regimens. The fluconazole group had a higher risk for development of invasive fungal infections within 90 days after allo-HSCT (43{\%} vs. 8.3{\%}, p = 0.039). Kaplan-Meier analysis indicated that the cumulative incidence of invasive fungal infection for 90 days after allo-HSCT was higher in the fluconazole group (log rank test, p = 0.047). Early discontinuation of antifungal prophylaxis for intolerance was significantly lower in the posaconazole group (8.3{\%} vs. 50{\%}, p = 0.017). Both groups had similar rates of impaired liver function. Conclusion: Analysis of primary fungal prophylaxis during the early neutropenic phase following allo-HSCT indicated that posaconazole was more effective and was better tolerated than fluconazole. Both drugs had similar safety profiles.",
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T1 - Clinical efficacy and safety of primary antifungal prophylaxis with posaconazole versus fluconazole in allogeneic blood hematopoietic stem cell transplantation recipients-A retrospective analysis of a single medical center in Taiwan

AU - Wang, Ching Hsun

AU - Kan, Li Ping

AU - Lin, Hsin An

AU - Chang, Feng Yee

AU - Wang, Ning Chi

AU - Lin, Te Yu

AU - Chao, Tsu Yi

AU - Kao, Woei Yau

AU - Ho, Ching Liang

AU - Chen, Yeu Chin

AU - Dai, Ming Shen

AU - Chang, Ping Ying

AU - Wu, Yi Ying

AU - Lin, Jung Chung

PY - 2014/4/28

Y1 - 2014/4/28

N2 - Background/Purpose: The efficacy and safety of posaconazole compared to fluconazole as antifungal prophylaxis in patients receiving allogeneic blood hematopoietic stem cell transplantation (allo-HSCT) during the early neutropenic phase without graft-versus-host disease (GVHD) was uncertain. Methods: The medical records of allo-HSCT recipients from a single institution, who received oral fluconazole (from January 2005 to June 2011) or oral posaconazole (from June 2011 to December 2013) during the early neutropenic phase (until engraftment), were retrospectively reviewed. Results: There were 52 allo-HSCT recipients, two of whom were younger than 18 years of age. Twelve cases received posaconazole and 40 cases received fluconazole as primary antifungal prophylaxis. The two groups had similar transplant characteristics, conditioning, and GVHD prophylaxis regimens. The fluconazole group had a higher risk for development of invasive fungal infections within 90 days after allo-HSCT (43% vs. 8.3%, p = 0.039). Kaplan-Meier analysis indicated that the cumulative incidence of invasive fungal infection for 90 days after allo-HSCT was higher in the fluconazole group (log rank test, p = 0.047). Early discontinuation of antifungal prophylaxis for intolerance was significantly lower in the posaconazole group (8.3% vs. 50%, p = 0.017). Both groups had similar rates of impaired liver function. Conclusion: Analysis of primary fungal prophylaxis during the early neutropenic phase following allo-HSCT indicated that posaconazole was more effective and was better tolerated than fluconazole. Both drugs had similar safety profiles.

AB - Background/Purpose: The efficacy and safety of posaconazole compared to fluconazole as antifungal prophylaxis in patients receiving allogeneic blood hematopoietic stem cell transplantation (allo-HSCT) during the early neutropenic phase without graft-versus-host disease (GVHD) was uncertain. Methods: The medical records of allo-HSCT recipients from a single institution, who received oral fluconazole (from January 2005 to June 2011) or oral posaconazole (from June 2011 to December 2013) during the early neutropenic phase (until engraftment), were retrospectively reviewed. Results: There were 52 allo-HSCT recipients, two of whom were younger than 18 years of age. Twelve cases received posaconazole and 40 cases received fluconazole as primary antifungal prophylaxis. The two groups had similar transplant characteristics, conditioning, and GVHD prophylaxis regimens. The fluconazole group had a higher risk for development of invasive fungal infections within 90 days after allo-HSCT (43% vs. 8.3%, p = 0.039). Kaplan-Meier analysis indicated that the cumulative incidence of invasive fungal infection for 90 days after allo-HSCT was higher in the fluconazole group (log rank test, p = 0.047). Early discontinuation of antifungal prophylaxis for intolerance was significantly lower in the posaconazole group (8.3% vs. 50%, p = 0.017). Both groups had similar rates of impaired liver function. Conclusion: Analysis of primary fungal prophylaxis during the early neutropenic phase following allo-HSCT indicated that posaconazole was more effective and was better tolerated than fluconazole. Both drugs had similar safety profiles.

KW - Fluconazole

KW - Posaconazole

KW - Prophylaxis

KW - Transplantation

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