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Post-Transplant Events

Clinical efficacy and safety of primary antifungal prophylaxis with posaconazole vs itraconazole in allogeneic blood and marrow transplantation

Bone Marrow Transplantation volume 46, pages 733–739 (2011)Cite this article

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Abstract

Posaconazole has been recently approved for primary antifungal prophylaxis in patients with prolonged neutropenia after AML induction chemotherapy and patients with GVHD. We now present the first experience of the efficacy and safety of posaconazole during the early phase of post-allogeneic BMT (n=33; from June 2007), in comparison with itraconazole primary prophylaxis (n=16; up to May 2007). More patients receiving posaconazole were T-cell depleted (P=0.003). Groups were otherwise comparable in terms of age, sex, disease, neutrophil engraftment, incidence of GVHD, use of unrelated donors and type of conditioning. Safety data as well as the incidence of fever (84%) and persistent fever (27%) during the 100-day treatment period were comparable for both antifungal agents. Patients receiving posaconazole had a lower cumulative incidence of proven or probable invasive fungal disease, as defined by the European Organization for Research and Treatment of Cancer criteria (0 vs 12%; P=0.04), which associated with a higher probability of fungal-free survival (91 vs 56%; P=0.003) and an improved probability of OS (91 vs 63%; P=0.011) compared with patients receiving itraconazole. Our single-centre experience suggests that antifungal prophylaxis with posaconazole may lead to a better outcome than itraconazole for patients in the early high-risk neutropenic period after allogeneic BMT.

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Acknowledgements

This study was partly supported by an unrestricted research grant from Schering-Plough.

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Authors and Affiliations

  1. Departme,

    I Sánchez-Ortega, B Patiño, M Arnan, T Peralta, R Parody, M Encuentra, A Fernández de Sevilla & R F Duarte

  2. nt of Haematology, Catalan Institute of Oncology, Hospital Duran i Reynals, Barcelona, Spain

    I Sánchez-Ortega, B Patiño, M Arnan, T Peralta, R Parody, M Encuentra, A Fernández de Sevilla & R F Duarte

  3. Infectious Diseases Unit, Catalan Institute of Oncology, Hospital Duran i Reynals, Barcelona, Spain

    C Gudiol

  4. Universitat Autonoma de Barcelona, Barcelona, Spain

    I Sánchez-Ortega

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  1. I Sánchez-Ortega
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Correspondence to R F Duarte.

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Competing interests

Drs Arnan, Duarte, Fernández de Sevilla, Gudiol and Parody have received consultation and/or speaker fees from Esteve, Gilead Science, Merck Sharp and Dohme, Pfizer and/or Schering-Plough during the study period. Other authors declare no conflict of interest.

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Sánchez-Ortega, I., Patiño, B., Arnan, M. et al. Clinical efficacy and safety of primary antifungal prophylaxis with posaconazole vs itraconazole in allogeneic blood and marrow transplantation. Bone Marrow Transplant 46, 733–739 (2011). https://doi.org/10.1038/bmt.2010.185

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