Publication: Antifungal prophylaxis with posaconazole versus fluconazole in children with neutropenia following allogeneic hematopoietic stem cell transplantation: Single center experience
Issued Date
2021-01-01
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11792736
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2-s2.0-85112114748
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Mahidol University
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SCOPUS
Bibliographic Citation
Journal of Blood Medicine. Vol.12, (2021), 679-689
Suggested Citation
Chayamon Takpradit, Chonthida Wangkittikal, Supattra Rungmaitree, Jassada Buaboonnam, Nattee Narkbunnam, Kamon Phuakpet, Nassawee Vathana, Kleebsabai Sanpakit, Bunchoo Pongtanakul Antifungal prophylaxis with posaconazole versus fluconazole in children with neutropenia following allogeneic hematopoietic stem cell transplantation: Single center experience. Journal of Blood Medicine. Vol.12, (2021), 679-689. doi:10.2147/JBM.S319890 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/78665
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Title
Antifungal prophylaxis with posaconazole versus fluconazole in children with neutropenia following allogeneic hematopoietic stem cell transplantation: Single center experience
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Abstract
Background: Invasive fungal diseases (IFDs) are common and contribute to mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). The relative efficacies of posaconazole (POS) and fluconazole (FLU) as primary antifungal prophylaxes are uncertain. Methods: A retrospective study was performed on children treated with allogeneic HSCT who received POS or FLU during the early neutropenic period. The efficacies, safety, and tolerabilities of the prophylaxes were compared. Results: Data on 78 HSCT recipients were analyzed. Most had thalassemia (58%). Pre-engraftment, POS and FLU were administered to 41 and 37 cases, respectively. There were no proven cases of IFD. However, 2 POS cases and 1 FLU case had probable IFDs. The IFD incidences of the POS (5%) and FLU (3%) groups demonstrated no statistical difference (p = 0.620). Of the 75 surviving cases receiving FLU post-engraftment (including 39 cases previously given POS), 3 had proven IFDs whereas 3 had probable IFDs (total, 6 [8%]) within 1 year post-HSCT. No cases discontinued the prophylaxes due to drug intolerance. The common adverse events with POS and FLU were not significantly different. Only 19% of the patients achieved the therapeutic POS level, with a starting dose of 4 mg/kg thrice daily. Conclusion: POS and FLU demonstrate comparable levels of effectiveness, safety, and tolerability as IFD prophylaxes for neutropenic children treated with allogeneic HSCT. Determination of the optimum POS dose and duration requires larger studies.