Posaconazole oral suspension for secondary antifungal prophylaxis in allogeneic stem cell transplantation recipients: a retrospective study

• Published in: BMC infectious diseases Vol. 22; no. 1; p. 465
• Main Authors: Ye, Peipei, Pei, Renzhi, Hu, Youqian, Chen, Dong, Li, Shuangyue, Cao, Junjie, Li, Fenglin, Wu, Mengjie, Fang, Ying, Lu, Ying
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 15.05.2022; BioMed Central; BMC
• Subjects: Allogeneic hematopoietic stem cell transplantation; Antifungal agents; Antifungal Agents - therapeutic use; Cytomegalovirus; Disease prevention; Dosage and administration; Drug dosages; Failure; Fungal diseases; Fungicides; Graft versus host disease; Health risks; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Humans; Invasive fungal diseases; Invasive Fungal Infections - drug therapy; Invasive Fungal Infections - etiology; Invasive Fungal Infections - prevention & control; Leukemia; Patient outcomes; Patients; Posaconazole; Prophylaxis; Retrospective Studies; Risk analysis; Risk factors; Secondary antifungal prophylaxis; Statistical analysis; Stem cell transplantation; Stem cells; Transplantation; Triazoles - therapeutic use; China; Allogeneic hematopoietic stem cell transplantation; Secondary antifungal prophylaxis; Invasive fungal diseases; Posaconazole
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-022-07442-y

There is no consensus on the optimal secondary antifungal prophylaxis (SAP) regimen in patients receiving allogeneic hematopoietic stem cell transplantation (allo-HSCT). The purpose of this study was to evaluate the efficacy and safety of posaconazole oral suspension as secondary prophylaxis of invasive fungal disease (IFD) for allo-HSCT patients. We retrospectively reviewed clinical data from prior IFD patients who received posaconazole oral suspension as systemic antifungal prophylaxis between June 2016 and January 2021 and have a follow-up period of 1 year after HSCT. The clinical outcomes of patients with a prior history of IFD (n = 30) and those without (n = 93) were compared. The 1-year cumulative incidence of prophylaxis failure was 58.3% in the group with prior history of IFD and 41.6% in the group without a prior history of IFD (p = 0.459). The cumulative incidence of proven, probable or possible IFD within 1 year after allo-HSCT was 23.1% in the group with prior history of IFD and 14.1% in the group without prior history of IFD (p = 0.230). There was no significant difference between the cumulative incidence of proven or probable IFD within 1-year after allo-HSCT in the group with a prior history of IFD and the group without (p = 0.807). Multivariate logistic regression revealed cytomegalovirus disease as risk factor for post-transplantation IFD occurrence in posaconazole oral suspension prophylaxis. There was not a significant difference in overall survival between the patients with IFD history and those without (P = 0.559). Our study support that allo-HSCT recipients with a prior history of IFD and normal GI absorption can choose posaconazole oral suspension as a safe and effective SAP option.