Table 2.
Summary of published reports of studies of patients with hematological malignancies and histories of IFIs who received secondary antifungal prophylaxis and underwent further chemotherapy and/or hematopoietic stem cell transplantation
| Reference | Study type | Patient population1 | Prior IFI2 | Drug3 | Treatment duration | Prophylaxis stopped/adverse effects | Breakthrough IFI | Comments |
|---|---|---|---|---|---|---|---|---|
| Mele et al. [17] | Case reports | Two patients with AML and PA who received consolidation therapy and chemotherapy, respectively | IA | L-AmB (1 mg/kg/day) | 13–16 days | 0/2 | 0/2 | L-AmB use discontinued after cell-count recovery |
| Sevilla et al. [18] | Case series | 7 patients with leukemia undergoing peripheral blood SCT | IA | (5) Itra + L-AmB (1) Itra (1) L-AmB |
4–22 months 3 months 48 months |
0/5 0/1 0/1 |
0/5 0/1 0/1 |
Absence of microbiological data in 4 patients |
| Nosari et al. [19] | Case series | 24 patients; 9 underwent SCT (6 allo, 1 MUD and 2 auto), 2 of them underwent prior pulmonary lobectomy and 15 patients with leukemia on continued chemotherapy | IA | (4) Itra (5) L-AmB L-AmB + Itra (3 mg/kg/day) Amp B + Itra (1 mg/kg/day) |
ND | ND | 3/24 | Overlap between treatment and secondary prophylaxis |
| Tedeshi et al. [20] | Case report | 1 patient with AML undergoing 2 courses of consolidation therapy and auto SCT | M | L-AmB (1 mg/kg/day) | 14 days | 0/1 | 0/1 | |
| Cordonnier et al. [21] | Case series | 11 patients with leukemia undergoing allo SCT (9) or consolidation therapy (2) | IA (10) IC (1) |
Vori (400mg/day) | 44–245 days | 0/11 | 0/11 | |
| Kruger et al. [22] | Case series | 43 patients undergoing SCT (2 auto, 41 peripheral blood SCT) | IA (11) IC (1) |
L-AmB (0.6–6.5 mg/kg/day) | 2–54 days | 0/43 | ND | L-AmB was started after the onset of fever or pulmonary infiltrates. IFI related death 28% (12/43) |
| Vaidya et al. [23] | Case series | 27 patients undergoing SCT (15 auto, 12 allo) 9 patients with surgical excision of IFI | IA (19) | (12) Itra (5 mg/kg/day) (12) Amp B (0.5 mg/kg/day) (1) Vori (8 mg/kg/day) (2) Fluco (3 mg/kg/day) |
ND | ND | 3/27 | |
| Nosari et al. [24] | Case series | 6 patients with leukemia had pulmonary surgery for IFI and underwent SCT (3 allo, 3 auto) | IA (4) M (1) |
(5) L-AmB (3 mg/kg/day) (1) Vori (400 mg/day) |
ND | ND | 0/6 | |
| De Fabritis et al. [25] | Retrospective | 18 patients with hematological malignancies underwent allo SCT | IA (5) IC (1) |
Caspo (50 mg/day) | ND | 0/18 | 2/18 | Overlap between continuation of treatment and prophylaxis |
| Cornely et al. [26] | Prospective survey | 124 patients with AML, 14.5% had surgical resection of the IFI | ND | (50) Itra (24) Vori (17) Amb B (10) L-AmB (4) Caspo |
ND | ND | 26/124 | Study was focus on risk factors for breakthrough IFI |
| Zhang et al. [27] | Retrospective | 49 patients with ALL (25), AML (10), other (14) who underwent SCT (20 auto, 29 allo) | ND | (23) Vori (20) Itra (3) Caspo (2) Fluco (1) Amp B |
15–110 days | 0/49 | 9/49 | 6.4% IFI-related mortality at 2 years after transplantation. 23 cases with prior possible IFI |
| Vehreschild et al. [4] | Retrospective | 75 patients with AML (61), ALL (10), lymphoma (3) and BPL (1) undergoing chemotherapy or SCT (20 allo, 4 auto) | IA (11) IC (2) |
(28) Caspo (50–70 mg/kg/day) (47) Itra (400–600 mg/kg/day) |
ND | 2/75 | 9/28 15/47 |
Despite antifungal prophylaxis, risk of breakthrough IFI was high in both groups |
| Cordonnier et al. [28] | Prospective Open Label | 45 patients (41 acute leukemia) | IA (31 ) IC (5) |
Vori (400 mg/kg/day) | 5–180 days | 3/45 | 2/45 |
1
AML, acute myeloid leukemia; PA, primary amyloidosis; SCT, stem cell transplantation; allo, allogeneic; auto, autologous; MUD, matched unrelated donor; ALL, acute lymphocytic leukemia; BPL, biphenotypic leukemia.
2
IA, invasive aspergillosis; IC, invasive candidiasis; M, mucormycosis; ND, no data.
3
Itra, itraconazole; Vori, voriconazole; Fluco, fluconazole; Caspo, caspofungin.