A pilot study of targeted itraconazole prophylaxis in patients with graft-versus-host disease at high risk of invasive mould infections following allogeneic stem cell transplantation

Bone Marrow Transplantation
Andrew GriggMonica A Slavin

Abstract

Patients with severe graft-versus-host disease (GVHD) requiring intensive immunosuppression are at high risk of invasive mould infections (IMI). Prophylaxis with an active, oral antifungal agents with reliable absorption in this context is desirable. A total of 44 patients at high risk of post-engraftment IMI received itraconazole solution 2.5 mg/kg b.d. as prophylaxis. Two of the first nine patients, in whom bioavailability was compromised due to significant vomiting and/or diarrhoea, died of probable or proven invasive aspergillus. None of the subsequent 35 patients, some of whom had severe gut GVHD and who received liposomal amphotericin B prophylaxis until itraconazole was reliably tolerated and absorbed, developed IMI. The overall incidence of IMI was substantially lower than in historical controls. Itraconazole was generally well tolerated, with five patients (11%) ceasing the drug due to intolerance or disturbed liver function. Targeted prophylaxis with oral or parenteral antifungal agents in high-risk allograft recipients appears to be effective in reducing the incidence of IMI.

References

Aug 1, 1994·The American Journal of Medicine·D W DenningA Catanzaro
Apr 1, 1994·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·M R O'DonnellE P Smith
Aug 1, 1993·European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology·G TodeschiniP Montresor
Jan 1, 1997·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·D CaillotH Guy
Apr 1, 1997·Bone Marrow Transplantation·E JantunenT Ruutu
Jul 1, 1997·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·K Y YuenT K Chan
Mar 4, 1999·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·P RibaudE Gluckman
Jun 17, 1999·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·J R Wingard
Jun 14, 2001·Lancet·S R AhmadB G Leissa
Dec 4, 2001·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·S AsciogluUNKNOWN Mycoses Study Group of the National Institute of Allergy and Infectious Diseases
Dec 27, 2002·The New England Journal of Medicine·Adilia WarrisPaul E Verweij
Sep 25, 2003·Blood·Kieren A MarrGeorge B McDonald
Dec 5, 2003·Lancet·Michail S Lionakis, Dimitrios P Kontoyiannis
Dec 16, 2003·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Axel GlasmacherIngo G H Schmidt-Wolf

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Citations

Aug 8, 2013·Transplantation·Patricia MuñozEmilio Bouza
Jul 1, 2008·Internal Medicine Journal·M A SlavinA P Grigg
Jul 4, 2007·Transplant Infectious Disease : an Official Journal of the Transplantation Society·A Grigg, M Slavin
Apr 27, 2012·British Journal of Haematology·Fiona L DignanUNKNOWN British Society for Blood and Marrow Transplantation
Feb 26, 2010·Transplant Infectious Disease : an Official Journal of the Transplantation Society·P ZhangM-Z Han
Jul 2, 2016·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Thomas F PattersonJohn E Bennett
Oct 3, 2007·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Eyal RobenshtokMical Paul
May 26, 2021·Antimicrobial Agents and Chemotherapy·Adriana M RauseoAndrej Spec

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