A reduced dose of fluconazole as primary antifungal prophylaxis is not associated with increased risk of invasive fungal infections after allogeneic stem cell transplantation from a HLA identical sibling. Issue 4 (16th May 2018) - Sarina, Barbara
Abstract: Background: Invasive fungal infections (IFI) represent a common side effect of allogeneic hematopoietic stem cell transplant (allo‐SCT), resulting in increased non relapse mortality (NRM) and reduced overall survival (OS) rates. Seventy‐five days of Fluconazole 400 mg/d represents the standard primary antifungal prophylaxis (PAP) after allo‐SCT, especially for low‐risk transplants. However, the ideal dosage of fluconazole has never been tested. Methods: Here, we report the experience of our institution on 113 consecutive patients receiving an allo‐SCT from a HLA identical sibling between 1999 and 2015, where PAP consisted of fluconazole 100 mg/d only during the pre‐engraftment phase. At the time of transplant, all patients were considered at low‐risk for mold infection according to ECIL‐5 guidelines. Results: Cumulative incidence of possible‐probable‐proven IFI was 11.7%, while proven‐probable (PP‐IFI) occurred in 5.5% of patients by day 100 post transplant. Of note, only 1 patient developed invasive Candidiasis due to a non‐albicans strain and stool‐screening tests were negative for colonization by Candida albicans species. The incidence of 1‐year acute and 2‐year chronic graft‐versus‐host‐disease (GVHD) was 30% and 45%, respectively. Three‐year OS and 1‐year NRM were 53% and 11.3%, respectively. Conclusion: In summary, fungal prophylaxis with fluconazole 100 mg/d results in very low incidence of PP‐IFI, GVHD and NRM in low‐risk allo‐SCT.