Posaconazole or Fluconazole for Prophylaxis in Severe Graft-versus-Host Disease

Abstract

Posaconazole was similar to fluconazole for prophylaxis against fungal infections among patients with GVHD. It was superior in preventing invasive aspergillosis and reducing the rate of deaths related to fungal infections. (ClinicalTrials.gov number, NCT00034645 [ClinicalTrials.gov].).

Management of infections in patients with chronic lymphocytic leukemia treated with alemtuzumab

“…The results of evidence-based trials suggest the use of fluconazole 400 mg/day administered orally as antifungal prophylaxis only in allogeneic SCT, but not in conventional chemo-or immunotherapy. Posaconazole was proven effective in preventing fungal infections and death in long-term neutropenic patients and in patients with GvHD after allogeneic SCT [9,57]; however, the dosage needed to treat patients receiving alemtuzumab remains unknown and the substance has not yet been tested in this setting. Similarly, little evidence is available to support the prophylactic use of itraconazole or liposomal amphotericin [7].…”

Incidence and risk factors of post-engraftment invasive fungal disease in adult allogeneic hematopoietic stem cell transplant recipients receiving oral azoles prophylaxis

“…1,2 Many studies, mainly from single-institution retrospective series, have analyzed the incidence and risk factors of these infections after alloSCT, 1,3-5 reporting a variable incidence ranging from 1 to 20%. 6,7 It is well established that severe neutropenia induced by conditioning regimens is associated with an increased risk of developing IFD after alloSCT, and it is generally accepted that antifungal prophylaxis should be administered in the pre-engraftment period. However, despite the knowledge of several post-engraftment risk factors associated with late IFD (for example, corticosteroid therapy and GVHD), considered as a guide for risk-adapted antifungal prophylaxis, the usefulness of such prophylaxis beyond the alloSCT engraftment is still controversial.…”

Safety and Pharmacokinetics of Isavuconazole as Antifungal Prophylaxis in Acute Myeloid Leukemia Patients with Neutropenia: Results of a Phase 2, Dose Escalation Study

“…Fluconazole, itraconazole, posaconazole, voriconazole, and micafungin are recommended for prophylactic use in patients with hematologic malignancies (9, 10). Although the results of randomized clinical trials support the prophylactic benefits of these agents (7,8,11), each may be limited in their use: fluconazole has no activity against molds (12); posaconazole demonstrates broad-spectrum activity against both yeasts and molds (13), but optimal absorption of the oral suspension of posaconazole is dependent on administration with a high-fat meal (however, the delayed-release tablets have improved bioavailability) (14); voriconazole is as effective as fluconazole in preventing IFIs (15) but has been associated with breakthrough mucormycosis and a high incidence of side effects (16, 17); itraconazole tablets have variable bioavailability, and its oral suspension has poor tolerability (18); and micafungin is available only as an intravenous (i.v.) formulation and has no activity against the Mucorales or Fusarium species (19).…”

“…Because IFIs are often difficult to diagnose, and delays in treatment can significantly increase the risk of mortality (5,6), antifungal prophylaxis has become a commonly used strategy in patients at high risk of IFIs (7,8). Fluconazole, itraconazole, posaconazole, voriconazole, and micafungin are recommended for prophylactic use in patients with hematologic malignancies (9,10).…”