A prospective feasibility study of primary prophylaxis against invasive fungal disease with voriconazole following umbilical cord blood transplantation with fludarabine-based conditioning

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• 作者：Shinsuke Takagi (1) (5)
  Hideki Araoka (2)
  Naoyuki Uchida (1)
  Yumiko Uchida (3)
  Daisuke Kaji (1)
  Hikari Ota (1) (4)
  Aya Nishida (5)
  Kazuya Ishiwata (1)
  Masanori Tsuji (1)
  Hisashi Yamamoto (1)
  Tadaaki Ito (3)
  Naofumi Matsuno (5)
  Go Yamamoto (1)
  Yuki Asano-Mori (1)
  Masahiro Hayashi (3)
  Koji Izutsu (1)
  Kazuhiro Masuoka (6)
  Atsushi Wake (5)
  Shigeyoshi Makino (4)
  Akiko Yoneyama (2)
  Shuichi Taniguchi (1) (7)
  
• 关键词：Voriconazole ; Prophylaxis ; Cord blood transplantation
• 刊名：International Journal of Hematology
• 出版年：2014
• 出版时间：May 2014
• 年：2014
• 卷：99
• 期：5
• 页码：652-658
• 全文大小：
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• 作者单位：Shinsuke Takagi (1) (5)
  Hideki Araoka (2)
  Naoyuki Uchida (1)
  Yumiko Uchida (3)
  Daisuke Kaji (1)
  Hikari Ota (1) (4)
  Aya Nishida (5)
  Kazuya Ishiwata (1)
  Masanori Tsuji (1)
  Hisashi Yamamoto (1)
  Tadaaki Ito (3)
  Naofumi Matsuno (5)
  Go Yamamoto (1)
  Yuki Asano-Mori (1)
  Masahiro Hayashi (3)
  Koji Izutsu (1)
  Kazuhiro Masuoka (6)
  Atsushi Wake (5)
  Shigeyoshi Makino (4)
  Akiko Yoneyama (2)
  Shuichi Taniguchi (1) (7)
  
  1. Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
  5. Department of Hematology, Toranomon Hospital Kajigaya, Kanagawa, Japan
  2. Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan
  3. Department of Pharmacy, Toranomon Hospital, Tokyo, Japan
  4. Department of Transfusion Medicine, Toranomon Hospital, Tokyo, Japan
  6. Department of Hematology, Mishuku Hospital, Tokyo, Japan
  7. Okinaka Memorial Institute for Medical Research, Tokyo, Japan
  
• ISSN：1865-3774

文摘

Despite the recent introduction of a new class of anti-Aspergillus agents, no standard regimen for the prevention of invasive fungal disease (IFD) following allogeneic hematopoietic stem cell transplantation has been shown to be superior to fluconazole. The present prospective, single-arm study investigated the feasibility of voriconazole (VOR) administration as primary prophylaxis in 52 recipients of umbilical cord blood transplantation (CBT) with fludarabine-based conditioning, who had no previous IFD episodes. Proven or probable IFD was determined using the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group, and the National Institute of Allergy and Infectious Diseases Mycoses Study Group?(EORTC/MSG) criteria were considered as breakthrough infections. VOR was administered as prophylaxis for a total of 6884 patient-days following CBT. The mean duration of VOR administration after transplantation was 132?days (range, 1-69); 44 patients (85?%) had advanced disease, 15 (29?%) had a history of allogeneic HSCT, and 29 (56?%) received systemic corticosteroid therapy for allogeneic immune-mediated complications. Under the prophylaxis with VOR, one patient developed probable invasive aspergillosis on day 71, and the cumulative incidence of IFD was 4.5?% at day 180. None of the patients developed breakthrough candida or zygomycetes infections. Under the extensive therapeutic dose monitoring, VOR was safely administered with a calcineurin inhibitor and was well tolerated. These results suggest that VOR represents a feasible primary prophylactic agent for IFD after CBT with fludarabine-based conditioning.