Early versus Late Fluconazole Prophylaxis in Autologous Hematopoietic Cell Transplantation

• Published in: Transplantation and cellular therapy Vol. 27; no. 8; pp. 681.e1 - 681.e5
• Main Authors: Guarana, Mariana, Nucci, Marcio, Barreiros, Gloria, Valeri, Julio, Almeida, Cecilia, Nouér, Simone A.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.08.2021
• Subjects: Autologous transplantation; Candidemia; Fluconazole; Hematopoietic cell transplantation; Mucositis; Prophylaxis; Hematopoietic cell transplantation; Mucositis; Candidemia; Fluconazole; Autologous transplantation; Prophylaxis; mucositis; fluconazole; hematopoietic cell transplantation; autologous; transplantation; candidemia; prophylaxis
• ISSN: 2666-6367; 2666-6367
• DOI: 10.1016/j.jtct.2021.04.019

•Fluconazole prophylaxis is used routinely in autologous hematopoietic cell transplantation recipients.•We compared the rates of candidemia in patients receiving prophylaxis starting with the conditioning regimen (early prophylaxis) or only when (and if) patients developed oral mucositis (late prophy;axis.•The rates of candidemia were similar with early and late prophylaxis with a reduction in the use of fluconazole. Candidemia is a major complication in hematopoietic cell transplantation (HCT), and antifungal prophylaxis with fluconazole decreases the incidence of this complication. We compared 2 strategies for fluconazole prophylaxis in patients with hematologic malignancy undergoing autologous HCT between 1997 and 2017. From 1997 to 2003, fluconazole prophylaxis (400 mg/d) was given to all HCTs, started with the conditioning regimen (early prophylaxis), and given until neutrophil engraftment or the need of non-prophylactic antifungal therapy. From 2004 on, fluconazole (400mg daily) was started only if (and when) the patient developed oral mucositis (late prophylaxis). Among 571 HCT, 270 received early prophylaxis, 112 received late prophylaxis, and 189 did not receive fluconazole because they did not develop oral mucositis. The incidence of candidemia was 1.8% in the early prophylaxis group, 0% in the late prophylaxis group, and 1.1% in the no prophylaxis group (P = .31). Among patients receiving fluconazole, the median duration of prophylaxis was 17 days (range, 6-36 days) in the early prophylaxis group and 6 days (range, 2-16 days) in the late prophylaxis group (P < .001). The initiation of fluconazole prophylaxis guided by the occurrence of oral mucositis (late prophylaxis) was as good as early fluconazole prophylaxis.