The Use of Voriconazole as Primary Prophylaxis for Invasive Fungal Infections in Patients Undergoing Allogeneic Stem Cell Transplantation: A Single Center's Experience.

Ali Atoui,Raquelle El Alam,Ali Bazarbachi,Souha S Kanj,Iman Abou Dalle,Nadine Omeirat,Jean El-Cheikh,Omar Fakhreddine,Zeina Kanafani

doi:10.3390/jof7110925

Ali Atoui, Raquelle El Alam + Show 7 more

Open Access

https://doi.org/10.3390/jof7110925

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Abstract

Background: Invasive fungal infections (IFI) following allogeneic stem cell transplant (allo-HCT) are associated with high morbidity and mortality. Primary prophylaxis using voriconazole has been shown to decrease the incidence of IFI. Methods: We conducted a retrospective analysis at the Bone Marrow Transplant (BMT) unit of the American University of Beirut including 195 patients who underwent allo-HCT for hematological malignancies and received voriconazole as primary prophylaxis for IFI. The primary endpoints were based on the incidence of IFI at day 100 and day 180, and the secondary endpoint based on fungal-free survival. Results: For the study, 195 patients who underwent allo-HCT between January 2015 and March 2021 were included. The median age at transplant was 43 years. Of the patients, 63% were male, and the majority of patients were diagnosed with acute myeloid leukemia (AML) (60%). Voriconazole was given for a median of 90 days and was interrupted in 20 patients. The majority of IFI cases were probable invasive aspergillosis (8%). The incidence of IFI including proven, probable and possible IFI was 34%. The incidence of proven and probable IFI was 5% were 8%, respectively. The incidence of proven-probable (PP-IFI) was 5.1% at day 100 and 6.6% at day 180. The majority of PP-IFI cases were invasive aspergillosis (8%). A univariate analysis of patients, transplant characteristics and IFI showed a significant correlation between the type of donor, disease status before transplant, graft-versus-host disease prophylaxis used and incidence of IFI. Only disease status post-transplant showed a significant correlation with fungal-free survival in the multivariate analysis. Conclusion: Primary prophylaxis with voriconazole in allo-HCT is associated with a low incidence of IFI. More studies are required to compare various antifungal agents in this setting.

Highlights

Invasive fungal infections (IFI) following allogeneic hematopoietic stem cell transplantation are associated with high morbidity and mortality
Fluconazole, Itraconazole and voriconazole are recommended for prophylaxis of IFI in allo-hematopoietic stem cell transplant (HCT) with no additional risk factors, with posaconazole recommended for patients with graftversus-host disease (GVHD)
We evaluated the efficacy of prophylactic voriconazole in allo-HCT for the prevention of IFI at a tertiary medical center in Lebanon

Summary

Introduction

Invasive fungal infections (IFI) following allogeneic hematopoietic stem cell transplantation (allo-HCT) are associated with high morbidity and mortality. Fewer IFI were observed with voriconazole in a subset of patients receiving allo-HCT for acute myeloid leukemia (AML) [4] Another trial comparing voriconazole and itraconazole following allo-HCT for 100–180 days showed the superiority of voriconazole in the primary endpoint after incorporating survival without proven/probable IFI at 180 days and the ability to tolerate the drug for 100 days, with less than 14 days interruption [5]. Methods: We conducted a retrospective analysis at the Bone Marrow Transplant (BMT) unit of the American University of Beirut including 195 patients who underwent allo-HCT for hematological malignancies and received voriconazole as primary prophylaxis for IFI. More studies are required to compare various antifungal agents in this setting

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