TY - JOUR
T1 - A prospective randomized trial of itraconazole vs fluconazole for the prevention of fungal infections in patients with acute leukemia and hematopoietic stem cell transplant recipients
AU - Oren, I.
AU - Rowe, J. M.
AU - Sprecher, H.
AU - Tamir, A.
AU - Benyamini, N.
AU - Akria, L.
AU - Gorelik, A.
AU - Dally, N.
AU - Zuckerman, T.
AU - Haddad, N.
AU - Fineman, R.
AU - Dann, E. J.
PY - 2006/7/2
Y1 - 2006/7/2
N2 - Fluconazole antifungal prophylaxis is standard care in allogeneic hematopoietic stem cell transplant (HSCT) recipients, but this drug lacks anti-Aspergillus activity, the primary cause of invasive fungal infection (IFI) in many transplantation centers. We performed a randomized trial to compare itraconazole vs fluconazole, for prevention of IFIs in patients with acute leukemia (AL) and HSCT recipients. One hundred and ninety-five patients were randomly assigned to either fluconazole or itraconazole antifungal prophylaxis, after stratification into high-risk and low-risk groups. Antifungal prophylaxis was started at the beginning of chemotherapy and continued until resolution of neutropenia, or until amphotericin B treatment was started. IFI occurred in 11 (11%) of itraconazole, and in 12 (12%) fluconazole recipients. Invasive candidiasis (IC) developed in two (2%) itraconazole and one (1%) fluconazole recipients, while invasive aspergillosis (IA) developed in nine (9%) itraconazole and 11(11%) fluconazole recipients. There was no difference in the incidence of total IFI, IC and IA between the two study arms. However, there was a nonsignificant trend towards reduced mortality among patients who developed IA while receiving itraconazole prophylaxis (3/9 = 33% vs 8/11 = 73%, P = 0.095).
AB - Fluconazole antifungal prophylaxis is standard care in allogeneic hematopoietic stem cell transplant (HSCT) recipients, but this drug lacks anti-Aspergillus activity, the primary cause of invasive fungal infection (IFI) in many transplantation centers. We performed a randomized trial to compare itraconazole vs fluconazole, for prevention of IFIs in patients with acute leukemia (AL) and HSCT recipients. One hundred and ninety-five patients were randomly assigned to either fluconazole or itraconazole antifungal prophylaxis, after stratification into high-risk and low-risk groups. Antifungal prophylaxis was started at the beginning of chemotherapy and continued until resolution of neutropenia, or until amphotericin B treatment was started. IFI occurred in 11 (11%) of itraconazole, and in 12 (12%) fluconazole recipients. Invasive candidiasis (IC) developed in two (2%) itraconazole and one (1%) fluconazole recipients, while invasive aspergillosis (IA) developed in nine (9%) itraconazole and 11(11%) fluconazole recipients. There was no difference in the incidence of total IFI, IC and IA between the two study arms. However, there was a nonsignificant trend towards reduced mortality among patients who developed IA while receiving itraconazole prophylaxis (3/9 = 33% vs 8/11 = 73%, P = 0.095).
KW - Acute leukemia
KW - Fluconazole
KW - Fungal infections
KW - Hematopoietic stem cell transplantation
KW - Itraconazole
UR - http://www.scopus.com/inward/record.url?scp=33745755772&partnerID=8YFLogxK
U2 - 10.1038/sj.bmt.1705418
DO - 10.1038/sj.bmt.1705418
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C2 - 16751782
AN - SCOPUS:33745755772
SN - 0268-3369
VL - 38
SP - 127
EP - 134
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
IS - 2
ER -