Lay Summary: A discussion of anti-fungal prophylaxis for allogeneic stem cell transplant recipients.
Candida spp. and Aspergillus spp. are the most important fungal pathogens contributing to significant morbidity and mortality in immunocompromised patients. Yeast infections are mainly caused by fungi colonizing the gastrointestinal tract, which overgrow under antibacterial treatment and subsequently invade tissue and blood vessels during neutropenia. All allogeneic stem cell recipients should receive anti-fungal prophylaxis; traditionally fluconazole to prevent systemic infection with susceptible yeasts during neutropenia. A recent study published the superiority of itraconazole over fluconazole. However, oral administration of itraconazole is sometimes limited by gastrointestinal side-effects (BI). Voriconazole is a more recent alternative. Overall, antifungal prophylaxis is recommended at least until day +75 post transplant. If immunosuppression is given after day +75, as it would be after an allogeneic transplant, longer antifungal prophylaxis should be considered. A recent data published in the New England Journal of Medicine showed a clear role of posaconazole in terms of being efficacious and safe and prolonging survival. Voriconazole, being less recent is less studied but is very similar. Based on NCCN IF-3, it can be approved for 75+ days in total, since he optimal duration of therapy is not known and guidelines that recommend prophylaxis are silent on it duration, except that 75+ days is stated .Voriconazole, being less recent is less studied but is very similar to other drugs of the same class and should be considered to be an accepted option.
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