 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
Patients who have had ASCT usually have reduced immunity and problems fighting infections. In particular, they have high risks for serious (invasive) fungal infections. Doctors usually give patients who have had ASCT drugs for several months to try to prevent fungal infections. Some of the drugs have bad side effects, and infections are sometimes resistant to particular drugs. Which drug is the most effective and the least toxic is not clear.
SUMMARIES FOR PATIENTS
Preventing Fungal Infections in Patients with Stem-Cell Transplants
6 May 2003 | Volume 138 Issue 9 | Page I-37
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
The summary below is from the full report titled "Intravenous and Oral Itraconazole versus Intravenous and Oral Fluconazole for Long-Term Antifungal Prophylaxis in Allogeneic Hematopoietic Stem-Cell Transplant Recipients. A Multicenter, Randomized Trial." It is in the 6 May 2003 issue of Annals of Internal Medicine (volume 138, pages 705-713). The authors are D.J. Winston, R.T. Maziarz, P.H. Chandrasekar, H.M. Lazarus, M. Goldman, J.L. Blumer, G.J. Leitz, and M.C. Territo.
What is the problem and what is known about it so far?
Stem cells are immature blood cells that mature into red blood cells, white blood cells, and platelets. The mature cells carry oxygen to tissues, defend against infection, and prevent bleeding. Life-threatening problems result if patients don't produce stem cells or if powerful cancer treatments or immune body processes destroy stem cells. In either instance, doctors can replace stem cells and restore the body's ability to produce the blood cells that the patient needs. One method that doctors may use is allogeneic stem-cell transplantation (ASCT), in which patients receive healthy stem cells from an outside donor.
Why did the researchers do this particular study?
To find out which of two antifungal drugs (itraconazole and fluconazole) more effectively prevents fungal infections in patients who have had ASCT.
Who was studied?
140 patients who had ASCT from 5 transplantation centers.
How was the study done?
The researchers randomly assigned patients to receive either itraconazole or fluconazole. Drugs were started the day after ASCT. They were given through a vein for 2 weeks and then by mouth for 3 months. The researchers followed patients closely for 180 days after transplantation to assess side effects and any fungal infections. Then, they compared the numbers and the types of fungal infections and side effects in the two groups.
What did the researchers find?
Invasive fungal infections occurred in 9% of patients given itraconazole and in 25% of patients given fluconazole. Laboratory cultures revealed that fungal organisms were more often resistant to fluconazole than to itraconazole. Nausea, vomiting, diarrhea, and abdominal pain were more common with itraconazole.
What were the limitations of the study?
The doctors and the patients knew which drug the patients were taking. The study compared only two antifungal drugs. Other antifungal drugs need to be studied.
What are the implications of the study?
Itraconazole is better than fluconazole for preventing invasive fungal infections in ASCT recipients but causes more gastrointestinal side effects.
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  E. Robenshtok, A. Gafter-Gvili, E. Goldberg, M. Weinberger, M. Yeshurun, L. Leibovici, and M. Paul Antifungal Prophylaxis in Cancer Patients After Chemotherapy or Hematopoietic Stem-Cell Transplantation: Systematic Review and Meta-Analysis J. Clin. Oncol., December 1, 2007; 25(34): 5471 - 5489. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Oshima, Y. Kanda, Y. Asano-Mori, N. Nishimoto, S. Arai, S. Nagai, H. Sato, T. Watanabe, N. Hosoya, K. Izutsu, et al. Presumptive treatment strategy for aspergillosis in allogeneic haematopoietic stem cell transplant recipients J. Antimicrob. Chemother., August 1, 2007; 60(2): 350 - 355. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Ullmann, J. H. Lipton, D. H. Vesole, P. Chandrasekar, A. Langston, S. R. Tarantolo, H. Greinix, W. Morais de Azevedo, V. Reddy, N. Boparai, et al. Posaconazole or Fluconazole for Prophylaxis in Severe Graft-versus-Host Disease N. Engl. J. Med., January 25, 2007; 356(4): 335 - 347. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. A. Cornely, J. Maertens, D. J. Winston, J. Perfect, A. J. Ullmann, T. J. Walsh, D. Helfgott, J. Holowiecki, D. Stockelberg, Y.-T. Goh, et al. Posaconazole vs. Fluconazole or Itraconazole Prophylaxis in Patients with Neutropenia N. Engl. J. Med., January 25, 2007; 356(4): 348 - 359. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. Penack, S. Schwartz, P. Martus, M. Reinwald, M. Schmidt-Hieber, E. Thiel, and I. W. Blau Low-dose liposomal amphotericin B in the prevention of invasive fungal infections in patients with prolonged neutropenia: results from a randomized, single-center trial Ann. Onc., August 1, 2006; 17(8): 1306 - 1312. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. J. Hoeben, D. S. Burgess, J. T. McConville, L. K. Najvar, R. L. Talbert, J. I. Peters, N. P. Wiederhold, B. L. Frei, J. R. Graybill, R. Bocanegra, et al. In vivo efficacy of aerosolized nanostructured itraconazole formulations for prevention of invasive pulmonary aspergillosis. Antimicrob. Agents Chemother., April 1, 2006; 50(4): 1552 - 1554. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Charlier, E. Hart, A. Lefort, P. Ribaud, F. Dromer, D. W. Denning, and O. Lortholary Fluconazole for the management of invasive candidiasis: where do we stand after 15 years? J. Antimicrob. Chemother., March 1, 2006; 57(3): 384 - 410. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Glasmacher, O. Cornely, A. J. Ullmann, U. Wedding, H. Bodenstein, H. Wandt, C. Boewer, R. Pasold, H.-H. Wolf, M. Hanel, et al. An open-label randomized trial comparing itraconazole oral solution with fluconazole oral solution for primary prophylaxis of fungal infections in patients with haematological malignancy and profound neutropenia J. Antimicrob. Chemother., February 1, 2006; 57(2): 317 - 325. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Glasmacher and A. Prentice The role of meta-analysis in the evaluation of antifungal prophylaxis: authors' response J. Antimicrob. Chemother., January 1, 2006; 57(1): 152 - 154. [Full Text] [PDF]
|
|
|
|
 |
|
 E. J. Bow Of Yeasts and Hyphae: A Hematologist's Approach to Antifungal Therapy Hematology, January 1, 2006; 2006(1): 361 - 367. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Pfaller, L. Boyken, R. J. Hollis, S. A. Messer, S. Tendolkar, and D. J. Diekema In Vitro Susceptibilities of Clinical Isolates of Candida Species, Cryptococcus neoformans, and Aspergillus Species to Itraconazole: Global Survey of 9,359 Isolates Tested by Clinical and Laboratory Standards Institute Broth Microdilution Methods J. Clin. Microbiol., August 1, 2005; 43(8): 3807 - 3810. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. H. Kruger, J. Bohlius, O. A. Cornely, H. Einsele, H. Hebart, G. Massenkeil, S. Schuttrumpf, G. Silling, A. J. Ullmann, D. T. Waldschmidt, et al. Antimicrobial prophylaxis in allogeneic bone marrow transplantation. Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Haematology and Oncology Ann. Onc., August 1, 2005; 16(8): 1381 - 1390. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Golan Overview of transplant mycology Am. J. Health Syst. Pharm., April 15, 2005; 62(suppl_1): S17 - S21. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Singh and D. L. Paterson Aspergillus Infections in Transplant Recipients Clin. Microbiol. Rev., January 1, 2005; 18(1): 44 - 69. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Winston, C. Emmanouilides, K. Bartoni, G. J. Schiller, R. Paquette, M. C. Territo, K. A. Marr, and M. Boeckh Elimination of Aspergillus infection in allogeneic stem cell transplant recipients with long-term itraconazole prophylaxis: prevention is better than treatment Blood, September 1, 2004; 104(5): 1581 - 1582. [Full Text] [PDF]
|
|
|
|
 |
|
 J. H. Powers and K. M. Higgins Itraconazole versus Fluconazole for Antifungal Prophylaxis Ann Intern Med, April 6, 2004; 140(7): 580 - 580. [Full Text] [PDF]
|
|
|
|
|
|
M. Karthaus, O. A. Cornely, and A. J. Ullmann Itraconazole versus Fluconazole for Antifungal Prophylaxis Ann Intern Med, April 6, 2004; 140(7): 579 - 580. [Full Text] [PDF]
|
|
|
|
|
|
S. B. Mossad Itraconazole versus Fluconazole for Antifungal Prophylaxis Ann Intern Med, April 6, 2004; 140(7): 580 - 581. [Full Text] [PDF]
|
|
|
|
|
|
K. A. Marr, F. Crippa, W. Leisenring, M. Hoyle, M. Boeckh, S. A. Balajee, W. G. Nichols, B. Musher, and L. Corey Itraconazole versus fluconazole for prevention of fungal infections in patients receiving allogeneic stem cell transplants Blood, February 15, 2004; 103(4): 1527 - 1533. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. de Pauw Preventative use of antifungal drugs in patients treated for cancer J. Antimicrob. Chemother., February 1, 2004; 53(2): 130 - 132. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. R. Wingard, W. G. Nichols, and G. B. McDonald Supportive Care Hematology, January 1, 2004; 2004(1): 372 - 389. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Glasmacher, A. Prentice, M. Gorschluter, S. Engelhart, C. Hahn, B. Djulbegovic, and I. G.H. Schmidt-Wolf Itraconazole Prevents Invasive Fungal Infections in Neutropenic Patients Treated for Hematologic Malignancies: Evidence From a Meta-Analysis of 3,597 Patients J. Clin. Oncol., December 15, 2003; 21(24): 4615 - 4626. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. G. Nichols Management of Infectious Complications in the Hematopoietic Stem Cell Transplant Recipient J Intensive Care Med, November 1, 2003; 18(6): 295 - 312. [Abstract] [PDF]
|
|
|
|
 |
|
 S Doffman Prophylactic itraconazole may decrease the rate of invasive fungal infection in allogeneic haematopoietic stem cell transplant recipients Thorax, August 1, 2003; 58(8): 669 - 669. [Full Text]
|
|
|
|
 |
|
 Which Azole to Stem Fungal Infections in Stem-Cell Recipients? Journal Watch Infectious Diseases, June 20, 2003; 2003(620): 4 - 4. [Full Text]
|
|
|
|
|
|
S. N. O'Brien, N. M.A. Blijlevens, T. H. Mahfouz, and E. J. Anaissie Infections in Patients with Hematological Cancer: Recent Developments Hematology, January 1, 2003; 2003(1): 438 - 472. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Article
