Song, A., Yang, D.L., Huang, Y., Jiang, E.L., Yan, Z.S., Wei, J.L., . . . Han, M.Z. (2010). Secondary antifungal prophylaxis in hematological malignancies in a tertiary medical center. International Journal of Hematology, 92, 725–731.
The purpose of the study was to Investigate efficacy of secondary antifungal prophylaxis (SAP) .
Primary antifungal prophylaxis was fluconazole 200 mg PO daily. Patients with documented IFI were treated with intensive antifungal therapy. Two of these had complete response prior to futher treatment of primary disease. Thirty-three patients received prophylaxis with voriconazole, 21 received itraconazole, two received micafungin, and one received amphotericin B. The antifungal prophylaxis continued through time of neutropenia and ended when eradication of residual diseases or initiation of salvage therapy due to failure of SAP.
Active treatment (i.e., chemotherapy or stem cell transplantation)
Retrospective chart review
Median follow-up 120 days (12–1,080) revealed 11 failures of SAP, representing 7.4 per 100 cycles of therapy and cumulative incidence of 24.5% at end of follow-up. Four experienced infection progression, three had infection recurrence, and the other four had breakthrough infection. Of the 11 failures, five occurred in the allo-HSCT and six during chemotherapy. High-dose steroids and neutropenia of more than 14 days were identified as risk factors for SAP failure.
SAP demonstrated high efficacy and can protect further chemotherapy and SCT. Two risk factors, high-dose steroids and neutropenia longer than 14 days, were identified as factors of prophylaxis failure and these patients were deemed to require special consideration.
Based on small sample size and study design, evidence is weak in recommendation for practice.