Fungal infection is one of the most important causes of morbidity and mortality in hemopoeitic stem cell transplant (HSCT) recipients. The growing incidence of fungal infection is related to several factors including prolonged granulocytopenia, use of broad-spectrum antibiotics, conditioning regimens, and use of immunosuppression to avoid graft-versus-host disease. Amphotericin B with or without 5-flucytosine is considered the standard therapy for acute candidiasis with fluconazole as an alternative. Amphotericin B is also the first-line therapy for invasive aspergillosis in neutropenic patients. However nephrotoxicity is a major side effect of amphothericin B, particularly in patients with HSCT needing cyclosporine concurrently with amphotericin B. Both of these drugs are nephrotoxic and impaired renal function may be observed. Even with the development of the liposomal formulations of amphotericin B, there is still about a 20% risk of nephrotoxicity. Possible liposomal amphotericin B-induced nephrogenic diabetes insipidus has also been reported. Third generation triazoles have become available and have broadened the spectrum of effects against invasive aspergillosis. The efficacy of voriconazole (VRC) in the treatment of invasive aspergillosis in patients with acute myeloid leukemia undergoing HSCT has been reported. However there is no report regarding the adverse effects of VRC in the management of HSCT patients (PubMed Jan. 2001-Oct. 2003). Therefore we conducted this retrospective study to assess the adverse effects of VRC in HSCT patients (Jan. 2002 to Oct. 2003) and to evaluate the safety of the empiric use of VRC in HSCT patients. A total of 31 patients post HSCT received VRC. The characteristics of the patients are shown in table.1. All adverse events and laboratory abnormalities during treatment and follow-up were recorded and their relationship to VRC was determined. There were two patients with mild elevation in liver function tests not necessitating discontinuation of VRC with spontaneous normalization of liver function tests while on VRC. There was one patient with confusion, noted three days after the initiation of VRC while on narcotics. The confusion resolved upon discontinuing VRC and adjusting narcotics. VRC was not restarted due to resolution of fever and engraftment. Unlike prior reports we did not observe any skin rashes or visual disturbances. Our experience confirms the safety and tolerability of VRC in HSCT patients. TableNumber of patients31Mean age (range)48 (25–65)SexMale 24 (77%), Female 7 (23%)Underlying diseaseAML 11 (36%), NHL 7 (22%), HD 4 (13%), MM 4 (13%), ALL 3 (10%), CML 1 (3%), Germ cell 1 (3%)Type of HSCTAuto 28 (90%), Allo 3 (10%)Mean days of neutropeina (range)19 (7–57)Route of VRC administrationPO 15 (49%), IV 10 (32%), IV+PO 6 (19%)Dose of VRC400mg q12hr for two doses then 200mg q 12hrMean days of VRC administration (range)13 (2–45)Adverse effectsElevation of LFT’s 2 (6%), Confusion 1 (3%)HSCT, hemopoietc stem cell transplant; VRC, voriconazole; AMI, acute myeloid leukemia; CML, chronic myeloid leukemia; ALL, acute lymphoid leukemia; MM, multiple myeloma; HD, Hodgkin’s disease; NHL, non-Hodgkin’s lymphoma; LFT, liver function test.