Secondary prophylaxis of invasive fungal infection in haematopoietic stem cell recipients / 中华内科杂志

ABSTRACT

Objective To investigate the efficacy and safety of secondary anti-fungal prophylaxis (SAP) in haematopoietic stem cell recipients who had a history of antecedent invasive fungal infection(IFI). Methods The patients with hematological diseases,who were scheduled to undergo haernatopoietic stem cell transplantation (HSCT) in our unit from April 2005 to July 2008, received our routine conditioning regimen. Patients,who had a history of antecedent IFI,were given SAP from the start of conditioning chemotherapy until the end of the at-risk period. We chose the effective antifungal drug that was used for antecedent IFI as the secondary prophylaxis drug. Results There were 26 patients at entry. Six patients had probably adverse events (AEs) related to the secondary prophylaxis drug during the prophylactic process and the secondary prophylaxis terminated in two patients because of AEs. The remaining patients received SAP for a medium of 75 days (range 10-212 days). Relapsing IFI occurred in four patients during SAP and in one after SAP. The rate of reLapsing IFI was 19. 2% (5/26). The median time of re]apsing IFI was day 42(range,1-146). The mortality rate among relapsed patients was 60. 0% (3/5). No risk factors that might be associated with IFI was identified by logistic regression model. Conclusion Prior IFI is not an absolute contraindication for HSCT. Secondary antifungal prophylaxis can reduce the risk of recurrent infection in patients with prior IFI, but its schedule and time of therapy need further study.