GvHD after alloSCT: fluconazole-based prophylaxis reduces IFI

  • Christen D & al.
  • Leuk Lymphoma
  • 15 Jan 2019

  • curated by David Reilly
  • Univadis Clinical Summaries
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Takeaway

  • In patients who developed graft-versus-host disease (GVHD) after allogeneic stem cell transplantation (allo-SCT), fluconazole-based antifungal prophylaxis was associated with a low incidence of invasive fungal infection (IFI).

Why this matters

  • IFI is a significant complication after allo-SCT, for which GVHD is a significant risk factor.

Study design

  • Study to investigate IFI incidence and mortality rates in 290 patients with GVHD receiving fluconazole-based prophylaxis for IFI as standard after allo-SCT.
  • Patients with a prior history of possible/probable/proven fungal infection received mold-effective prophylaxis during and after allo-SCT.
  • Median patient age, 45 (range, 16-72) years.
  • 90/290 patients were at high risk for IFI.
  • Allo-SCT and subsequent treatment requiring hospitalization were performed with accompaniment of high-efficiency particulate air filtration.
  • Funding: Deutsche Forschungsgemeinschaft; Deutsche Krebshilfe; Jose Carreras Leukamie-Stiftung.

Key results

  • 8.97% overall incidence of IFI: 7.78% in high-risk patients (7/90), 3.85% incidence of mortality.
  • 117 (range, 6-701) days median time to IFI after allo-SCT.
  • Risk factors for IFI:
    • In the overall population:
      • Univariate analysis: prior history of IFI (P<.005>
      • Multivariate analysis: HR, 5.298; P=.001.​​​​​​​

Limitations

  • Retrospective data.