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A reduced dose of fluconazole as primary antifungal prophylaxis is not associated with increased risk of invasive fungal infections after allogeneic stem cell transplantation from a HLA identical sibling
Author(s) -
Sarina Barbara,
Mariotti Jacopo,
Bramanti Stefania,
Morabito Lucio,
Crocchiolo Roberto,
Rimondo Andrea,
Tordato Federica,
Pocaterra Daria,
Casari Erminia,
De Philippis Chiara,
CarloStella Carmelo,
Santoro Armando,
Castagna Luca
Publication year - 2018
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12906
Subject(s) - fluconazole , medicine , incidence (geometry) , candida albicans , transplantation , hematopoietic stem cell transplantation , cumulative incidence , graft versus host disease , immunology , gastroenterology , surgery , antifungal , biology , microbiology and biotechnology , physics , dermatology , optics
Background Invasive fungal infections ( IFI ) represent a common side effect of allogeneic hematopoietic stem cell transplant (allo‐ SCT ), resulting in increased non relapse mortality ( NRM ) and reduced overall survival ( OS ) rates. Seventy‐five days of Fluconazole 400 mg/d represents the standard primary antifungal prophylaxis ( PAP ) after allo‐ SCT , especially for low‐risk transplants. However, the ideal dosage of fluconazole has never been tested. Methods Here, we report the experience of our institution on 113 consecutive patients receiving an allo‐ SCT from a HLA identical sibling between 1999 and 2015, where PAP consisted of fluconazole 100 mg/d only during the pre‐engraftment phase. At the time of transplant, all patients were considered at low‐risk for mold infection according to ECIL ‐5 guidelines. Results Cumulative incidence of possible‐probable‐proven IFI was 11.7%, while proven‐probable ( PP ‐ IFI ) occurred in 5.5% of patients by day 100 post transplant. Of note, only 1 patient developed invasive Candidiasis due to a non‐albicans strain and stool‐screening tests were negative for colonization by Candida albicans species. The incidence of 1‐year acute and 2‐year chronic graft‐versus‐host‐disease ( GVHD ) was 30% and 45%, respectively. Three‐year OS and 1‐year NRM were 53% and 11.3%, respectively. Conclusion In summary, fungal prophylaxis with fluconazole 100 mg/d results in very low incidence of PP ‐ IFI , GVHD and NRM in low‐risk allo‐ SCT .