The Use of Voriconazole as Primary Prophylaxis for Invasive Fungal Infections in Patients Undergoing Allogeneic Stem Cell Transplantation: A Single Center’s Experience

Background: Invasive fungal infections (IFI) following allogeneic stem cell transplant (allo-HCT) are associated with high morbidity and mortality. Primary prophylaxis using voriconazole has been shown to decrease the incidence of IFI. Methods: We conducted a retrospective analysis at the Bone Marro...

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Autores principales:	Ali Atoui, Nadine Omeirat, Omar Fakhreddine, Raquelle El Alam, Zeina Kanafani, Iman Abou Dalle, Ali Bazarbachi, Jean El-Cheikh, Souha S. Kanj
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	hematological malignancies allogeneic transplant invasive fungal infection primary prophylaxis voriconazole Biology (General) QH301-705.5
Acceso en línea:	https://doaj.org/article/5102c1f85d63481f8bfc450ac264648b
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spelling	oai:doaj.org-article:5102c1f85d63481f8bfc450ac264648b2021-11-25T18:05:48ZThe Use of Voriconazole as Primary Prophylaxis for Invasive Fungal Infections in Patients Undergoing Allogeneic Stem Cell Transplantation: A Single Center’s Experience10.3390/jof71109252309-608Xhttps://doaj.org/article/5102c1f85d63481f8bfc450ac264648b2021-10-01T00:00:00Zhttps://www.mdpi.com/2309-608X/7/11/925https://doaj.org/toc/2309-608XBackground: Invasive fungal infections (IFI) following allogeneic stem cell transplant (allo-HCT) are associated with high morbidity and mortality. Primary prophylaxis using voriconazole has been shown to decrease the incidence of IFI. Methods: We conducted a retrospective analysis at the Bone Marrow Transplant (BMT) unit of the American University of Beirut including 195 patients who underwent allo-HCT for hematological malignancies and received voriconazole as primary prophylaxis for IFI. The primary endpoints were based on the incidence of IFI at day 100 and day 180, and the secondary endpoint based on fungal-free survival. Results: For the study, 195 patients who underwent allo-HCT between January 2015 and March 2021 were included. The median age at transplant was 43 years. Of the patients, 63% were male, and the majority of patients were diagnosed with acute myeloid leukemia (AML) (60%). Voriconazole was given for a median of 90 days and was interrupted in 20 patients. The majority of IFI cases were probable invasive aspergillosis (8%). The incidence of IFI including proven, probable and possible IFI was 34%. The incidence of proven and probable IFI was 5% were 8%, respectively. The incidence of proven-probable (PP-IFI) was 5.1% at day 100 and 6.6% at day 180. The majority of PP-IFI cases were invasive aspergillosis (8%). A univariate analysis of patients, transplant characteristics and IFI showed a significant correlation between the type of donor, disease status before transplant, graft-versus-host disease prophylaxis used and incidence of IFI. Only disease status post-transplant showed a significant correlation with fungal-free survival in the multivariate analysis. Conclusion: Primary prophylaxis with voriconazole in allo-HCT is associated with a low incidence of IFI. More studies are required to compare various antifungal agents in this setting.Ali AtouiNadine OmeiratOmar FakhreddineRaquelle El AlamZeina KanafaniIman Abou DalleAli BazarbachiJean El-CheikhSouha S. KanjMDPI AGarticlehematological malignanciesallogeneic transplantinvasive fungal infectionprimary prophylaxisvoriconazoleBiology (General)QH301-705.5ENJournal of Fungi, Vol 7, Iss 925, p 925 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	hematological malignancies allogeneic transplant invasive fungal infection primary prophylaxis voriconazole Biology (General) QH301-705.5
spellingShingle	hematological malignancies allogeneic transplant invasive fungal infection primary prophylaxis voriconazole Biology (General) QH301-705.5 Ali Atoui Nadine Omeirat Omar Fakhreddine Raquelle El Alam Zeina Kanafani Iman Abou Dalle Ali Bazarbachi Jean El-Cheikh Souha S. Kanj The Use of Voriconazole as Primary Prophylaxis for Invasive Fungal Infections in Patients Undergoing Allogeneic Stem Cell Transplantation: A Single Center’s Experience
description	Background: Invasive fungal infections (IFI) following allogeneic stem cell transplant (allo-HCT) are associated with high morbidity and mortality. Primary prophylaxis using voriconazole has been shown to decrease the incidence of IFI. Methods: We conducted a retrospective analysis at the Bone Marrow Transplant (BMT) unit of the American University of Beirut including 195 patients who underwent allo-HCT for hematological malignancies and received voriconazole as primary prophylaxis for IFI. The primary endpoints were based on the incidence of IFI at day 100 and day 180, and the secondary endpoint based on fungal-free survival. Results: For the study, 195 patients who underwent allo-HCT between January 2015 and March 2021 were included. The median age at transplant was 43 years. Of the patients, 63% were male, and the majority of patients were diagnosed with acute myeloid leukemia (AML) (60%). Voriconazole was given for a median of 90 days and was interrupted in 20 patients. The majority of IFI cases were probable invasive aspergillosis (8%). The incidence of IFI including proven, probable and possible IFI was 34%. The incidence of proven and probable IFI was 5% were 8%, respectively. The incidence of proven-probable (PP-IFI) was 5.1% at day 100 and 6.6% at day 180. The majority of PP-IFI cases were invasive aspergillosis (8%). A univariate analysis of patients, transplant characteristics and IFI showed a significant correlation between the type of donor, disease status before transplant, graft-versus-host disease prophylaxis used and incidence of IFI. Only disease status post-transplant showed a significant correlation with fungal-free survival in the multivariate analysis. Conclusion: Primary prophylaxis with voriconazole in allo-HCT is associated with a low incidence of IFI. More studies are required to compare various antifungal agents in this setting.
format	article
author	Ali Atoui Nadine Omeirat Omar Fakhreddine Raquelle El Alam Zeina Kanafani Iman Abou Dalle Ali Bazarbachi Jean El-Cheikh Souha S. Kanj
author_facet	Ali Atoui Nadine Omeirat Omar Fakhreddine Raquelle El Alam Zeina Kanafani Iman Abou Dalle Ali Bazarbachi Jean El-Cheikh Souha S. Kanj
author_sort	Ali Atoui
title	The Use of Voriconazole as Primary Prophylaxis for Invasive Fungal Infections in Patients Undergoing Allogeneic Stem Cell Transplantation: A Single Center’s Experience
title_short	The Use of Voriconazole as Primary Prophylaxis for Invasive Fungal Infections in Patients Undergoing Allogeneic Stem Cell Transplantation: A Single Center’s Experience
title_full	The Use of Voriconazole as Primary Prophylaxis for Invasive Fungal Infections in Patients Undergoing Allogeneic Stem Cell Transplantation: A Single Center’s Experience
title_fullStr	The Use of Voriconazole as Primary Prophylaxis for Invasive Fungal Infections in Patients Undergoing Allogeneic Stem Cell Transplantation: A Single Center’s Experience
title_full_unstemmed	The Use of Voriconazole as Primary Prophylaxis for Invasive Fungal Infections in Patients Undergoing Allogeneic Stem Cell Transplantation: A Single Center’s Experience
title_sort	use of voriconazole as primary prophylaxis for invasive fungal infections in patients undergoing allogeneic stem cell transplantation: a single center’s experience
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/5102c1f85d63481f8bfc450ac264648b
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The Use of Voriconazole as Primary Prophylaxis for Invasive Fungal Infections in Patients Undergoing Allogeneic Stem Cell Transplantation: A Single Center’s Experience

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