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Initial fluconazole prophylaxis may not be required in adults with acute leukemia or myelodysplastic/myeloproliferative disorders after reduced intensity conditioning peripheral blood stem cell allogeneic transplantation

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Abstract

In the myeloablative transplant setting, the early use of fluconazole prophylaxis provides a benefit in overall survival. Recent changes in transplantation practices, including the use of peripheral blood stem cells (PBSC) and/or reduced intensity conditioning (RIC) regimen may have favorably impacted the epidemiology of invasive fungal infections (IFI) after allogeneic stem cell transplantation (allo-SCT). Yet, the impact of removing fluconazole prophylaxis after RIC PBSC allotransplant is ill known. Here, a retrospective analysis was performed comparing patients who received fluconazole as antifungal prophylaxis (n = 53) or not (n = 56) after allo-SCT for acute leukemia or myelodysplastic/myeloproliferative syndrome. Sixteen IFI were documented (14 %) at a median time of 103 days after transplantation, including eight before day +100, at a similar rate, whether the patients received fluconazole prophylaxis (13 %) or not (16 %). IFI were due mainly to Aspergillus species (87 %), and only two Candida-related IFI (13 %) were documented in the non-fluconazole group before day +100. The incidences of IFI (overall, before or after day +100) as well as 3-year overall and disease-free survival, non-relapse mortality, or acute and chronic graft-versus-host disease (GVHD) were similar between both groups. In conclusion, this study suggests that fluconazole may not be required at the initial phase of RIC allo-SCT using PBSC. This result has to be confirmed prospectively while Aspergillus prophylaxis should be discussed in this particular setting.

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Contributions

EBD and PC designed, performed, and coordinated the research, collected, contributed, analyzed and interpreted the data, and wrote the manuscript.

XC performed the statistical analyses and critically revised the manuscript.

TG, JD, SA, PP, CP, JLH, NM, MCB, PM, and MM collected and contributed data, analyzed the results, and critically revised the paper.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Hematology Department and Centre d’Investigation Clinique en Cancérologie (CI2C), CHU Hotel-Dieu, Nantes, France

    Eolia Brissot, Thierry Guillaume, Jacques Delaunay, Sameh Ayari, Pierre Peterlin, Amandine Le Bourgeois, Marie-Christine Bene, Philippe Moreau & Patrice Chevallier

  2. Hematology Department, CHU, Rennes, France

    Xavier Cahu

  3. Institut de Cancerologie de l’Ouest (ICO), Centre René Gauducheau, Nantes Atlantique (Saint-Herblain), France

    Jean-Luc Harousseau

  4. Hematology Department, CHU de Bordeaux, Pessac, France

    Noel Milpied

  5. Hematology Department, Hopital Saint-Antoine, AP-HP, Paris, France

    Mohamad Mohty

  6. Service d’Hématologie Clinique, CHU Hôtel-Dieu, Place A. Ricordeau, 44093, Nantes Cedex, France

    Patrice Chevallier

Authors
  1. Eolia Brissot
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  2. Xavier Cahu
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  10. Marie-Christine Bene
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  13. Patrice Chevallier
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Correspondence to Patrice Chevallier.

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Brissot, E., Cahu, X., Guillaume, T. et al. Initial fluconazole prophylaxis may not be required in adults with acute leukemia or myelodysplastic/myeloproliferative disorders after reduced intensity conditioning peripheral blood stem cell allogeneic transplantation. Ann Hematol 94, 663–669 (2015). https://doi.org/10.1007/s00277-014-2259-x

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  • DOI: https://doi.org/10.1007/s00277-014-2259-x

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