Bow, E.J., Laverdiere, M., Lussier, N., Rotstein, C., Cheang, M.S. & Ioannou, S. (2002). Antifungal prophylaxis for severely neutropenic chemotherapy recipients: A meta analysis of randomized-controlled clinical trials. Cancer, 94, 3230–3246.
The evaluated treatment was antifungal prophylaxis with azoles (fluconazole, itraconazole, ketoconazole, and miconazole) or an amphotericin B formulation compared with placebo or no prophylaxis controls.
The search used MEDLINE and EMBASE (1966–2000); additional studies were identified from bibliographies/reference lists of articles, topical reviews, and information from the pharmaceutical industry and investigators in the field.
38 randomized, controlled trials
7,014 patients who received cytotoxic therapy for acute leukemia or hematopoietic stem cell transplantation (HSCT) sufficient to result in neutropenia (an absolute neutrophil count [ANC] of less than 1,000) lasting one week or more.
In severely neutropenic patients (ANC less than 1,000 for a week or more), antifungal prophylaxis reduced the use of:
In subgroup analyses, superficial fungal infections were not reduced for:
However, superficial fungal infections were reduced in HSCT recipients on azoles.
In subgroup analyses, fluconazole was more effective than itraconazole or low-dose amphotericin B formulations to prevent superficial fungal infections.
In subgroup analyses, a reduction in fungal infection-related mortality was not observed in:
There was a reduction in fungal infection-related mortality in trials using fluconazole for antifungal prophylaxis.
Antifungal prophylaxis did not affect: