Posaconazole for secondary antifungal prophylaxis in allogeneic stem cell transplantation recipients: a retrospective study

Abstract

Background There is no consensus on the optimal secondary antifungal prophylaxis (SAP) regimen in patients receiving allogeneic hematopoietic stem cell transplantation (allo-HSCT). The purpose of this study was to evaluate the efficacy and safety of posaconazole in the secondary prophylaxis of invasive fungal disease (IFD) in patients with allo-HSCT. Methods We retrospectively reviewed clinical data from prior IFD patients who received posaconazole as systemic antifungal prophylaxis between June 2016 and January 2021, with a follow-up period of 1 year after HSCT. The clinical outcomes of patients with a history of IFD (n = 30) and those without IFD (n = 93) were compared. Results The 1-year cumulative incidence of prophylaxis failure was 44.1% in the group without prior IFD and 50.0% in the group with a past history of IFD (p = 0.470). The cumulative incidence of confirmed, probable or possible IFD within 1 year after allo-HSCT was 15.4% in the group without prior IFD and 25.9% in the group with a past history of IFD (p = 0.148). Two risk factors for the develop of post-transplantation IFD of posaconazole prophylaxis were found, namely, cytomegalovirus disease and steroid treatment for more than 90 days after transplantation. A similar overall survival can be achieved between patients with a prior IFD and those free from a history of IFD. Conclusions Posaconazole appears to be a viable alternative to SAP in appropriately selected patients for allo-HSCT.