Isavuconazole prophylaxis in patients with hematologic malignancies and hematopoietic-cell transplant recipients.

Isavuconazole prophylaxis in patients with hematologic malignancies and hematopoietic-cell transplant recipients.

Clin Infect Dis. 2019 Apr 08;:

Authors: Fontana L, Perlin DS, Zhao Y, Noble BN, Lewis JS, Strasfeld L, Hakki M

Abstract
BACKGROUND: Isavuconazole (ISA) is an attractive candidate for primary mold-active prophylaxis in high-risk patients with hematologic malignancies (HM) or hematopoietic-cell transplant (HCT) recipients. However, data supporting the use of ISA for primary prophylaxis in these patients is lacking.
METHODS: We conducted a retrospective review of breakthrough invasive fungal infections (bIFIs) among adult HM patients and HCT recipients who received ≥ 7 days of ISA primary prophylaxis between 9/1/2016 and 9/30/2018. The incidence of bIFIs in patients receiving ISA was compared to those receiving posaconazole (POS) and voriconazole (VOR) during the same time period.
RESULTS: 145 patients received 197 courses of ISA prophylaxis. Twelve bIFIs (Aspergillus fumigatus (5), Aspergillus species (2), Mucorales (2), Fusarium species (2), and Candida glabrata (1)) occurred, representing 8.3% of patients and 6.1% of courses, after a median duration of 14 days of ISA prophylaxis. All bIFIs occurred during periods of neutropenia. Seven patients (58.3%) died within 42 days of onset of bIFI. bIFIs complicated 10.2% of ISA, 4.1% of POS, and 1.1% of VOR courses among patients with de novo or relapsed/refractory AML during the study period, with invasive pulmonary aspergillosis (IPA) complicating 6.8% of ISA courses, 1.3% of POS, and 0 VOR courses.
CONCLUSIONS: Although ISA has been approved for treatment of invasive Aspergillus and mucormycosis, we observed an increased rate of bIFI, notably IPA, using ISA for primary prophylaxis. These results support the need for further study to determine the role of ISA as primary prophylaxis.

PMID: 30958538 [PubMed – as supplied by publisher]

Source: Industry