Isavuconazole prophylaxis against invasive fungal infections in allogeneic stem cell transplantation: A single-center experience

Breakthrough invasive fungal infections on isavuconazole prophylaxis in hematologic malignancy & hematopoietic stem cell transplant patients

“…Even though ISA was well tolerated, the cumulative incidence of all bIFI cases was higher than that published in prior studies (3.2–8.5%), 14,15,17,19,22,24–27,30–32 but similar to Bose et al. (18%) 16 .…”

“…We evaluated for potential risk factors that could lead to the occurrence of bIFIs unfortunately, none were statistically significant. Even though ISA was well tolerated, the cumulative incidence of all bIFI cases was higher than that published in prior studies (3.2-8.5%), 14,15,17,19,22,[24][25][26][27][30][31][32] 16,19 . Although bIFIs with Candida and Aspergillus have been reported, 14,16,17,19,[22][23][24]26 we also had a significant number of Fusarium (3/13, 23.1%) and Mucor (3/13, 23.1%) species.…”

“…We attempted to compare certain patient characteristics such as number of patients with HM and TCT, underlying chemotherapy regimens, proportion of patients with R/R clinical status, and presence of graft-versus-host disease (GVHD); between our patient populations with those of prior studies. [14][15][16][17]19,[22][23][24][25][26][27][28][29][30][31][32] However, given the significant heterogeneity among the different patient groups, this was difficult to accomplish. 24 This heterogeneity of patient populations would also limit direct comparisons in all-cause mortality.…”

“…Another limitation is that as the selection of ISA as a prophylactic agent was at the discretion of the treating hematologist, this may have led to potential selection bias of higher‐risk patients. We attempted to compare certain patient characteristics such as number of patients with HM and TCT, underlying chemotherapy regimens, proportion of patients with R/R clinical status, and presence of graft‐versus‐host disease (GVHD); between our patient populations with those of prior studies 14–17,19,22–32 . However, given the significant heterogeneity among the different patient groups, this was difficult to accomplish 24 .…”

“…14,15 To date, there have been very few prospective studies that evaluated use of ISA as a prophylactic antifungal agent in patients with HM and/or TCT recipients-further data on the prophylactic efficacy of ISA in HM patients and TCT recipients is still lacking. 16,17 Breakthrough IFIs (bIFIs) have been reported in patients receiving prophylaxis with VOR (1.1−13%), 7,18,19 and POS (2−18.9%), [19][20][21] as well as those receiving ISA (3.2-16.3%), [14][15][16][17]19,[22][23][24][25][26][27][28][29][30][31][32] however, studies have not reported on risk factors related to bIFI occurrence.…”