Posaconazole Salvage Therapy Allows Successful Allogeneic Hematopoietic Stem Cell Transplantation in Patients With Refractory Invasive Mold Infections

Transpl Infect Dis. 2007 Jun;9(2):89-96. doi: 10.1111/j.1399-3062.2007.00208.x.

Abstract

We describe the clinical courses of 3 patients with hematologic malignancies (2 with acute myelogenous leukemia and 1 with multiple myeloma) who developed invasive fungal infections due to uncommon molds (Alternaria spp., Paecilomyces lilacinus, and Zygomycetes). Breakthrough invasive fungal infections of the sinus (n=1), lung (n=3), and pericardium (n=1) developed despite fluconazole prophylaxis and failed to respond to treatment with other licensed antifungal therapies, including amphotericin B (n=3), caspofungin (n=2), and voriconazole (n=3), and surgical intervention (n=2). Salvage therapy with posaconazole oral suspension resulted in successful outcomes in all 3 patients, who subsequently underwent allogeneic hematopoietic stem cell transplantation (HSCT) while on continued posaconazole therapy. The median duration of posaconazole treatment before HSCT was 5 months (range: 1.5-6 months). Posaconazole salvage therapy allowed successful allogeneic HSCT in 3 patients with refractory invasive mold infections.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antifungal Agents / therapeutic use*
  • Female
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Leukemia, Myeloid, Acute / therapy
  • Male
  • Middle Aged
  • Multiple Myeloma / therapy
  • Mycoses / drug therapy*
  • Prospective Studies
  • Salvage Therapy
  • Transplantation, Homologous
  • Triazoles / therapeutic use*

Substances

  • Antifungal Agents
  • Triazoles
  • posaconazole