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Blood, 15 February 2004, Vol. 103, No. 4, pp. 1527-1533. Prepublished online as a Blood First Edition Paper on October 2, 2003; DOI 10.1182/blood-2003-08-2644. This Article Full Text Full Text (PDF) All Versions of this Article: 2003-08-2644v1 103/4/1527    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Marr, K. A. Articles by Corey, L. Search for Related Content PubMed PubMed Citation Articles by Marr, K. A. Articles by Corey, L. Related Collections Neoplasia Transplantation Clinical Trials and Observations Related Article in Blood Online Related Letter in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  TRANSPLANTATION Itraconazole versus fluconazole for prevention of fungal infections in patients receiving allogeneic stem cell transplants Kieren A. Marr, Fulvio Crippa, Wendy Leisenring, Maggie Hoyle, Michael Boeckh, S. Arunmozhi Balajee, W. Garrett Nichols, Benjamin Musher, and Lawrence Corey From the Program of Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, WA; the Program of Clinical Statistics, Fred Hutchinson Cancer Research Center, Seattle, WA; the Department of Medicine, University of Washington, Seattle; and the Department of Laboratory Medicine, University of Washington, Seattle. Prophylactic fluconazole prevents candidiasis; however, this drug has no activity against molds. We performed a randomized trial to determine whether prophylactic itraconazole prevents invasive mold infections (IMIs). A total of 304 patients receiving allogeneic stem cell transplants (SCT) were randomized to receive fluconazole (400 mg/d) or itraconazole (oral solution 2.5 mg/kg 3 times daily, or intravenous 200 mg daily) for 180 days after SC transplantation, or until 4 weeks after discontinuation of graft-versus-host disease (GVHD) therapy. Proven or probable invasive fungal infections (IFI) were evaluated by intent-to-treat and "on-treatment" analyses. More patients in the itraconazole arm developed hepatotoxicities, and more patients were discontinued from itraconazole because of toxicities or gastrointestinal (GI) intolerance (36% versus 16%, P < .001). Intent-to-treat analysis demonstrated no difference in the incidence of IFI during the intended study period (fluconazole 16% versus itraconazole 13%, P = .46); however, fewer patients in the itraconazole arm developed IFI on treatment (fluconazole 15% versus itraconazole 7%, P = .03). Itraconazole provided better protection against IMI (fluconazole 12% versus itraconazole 5%, P = .03), but similar protection against candidiasis (3% versus 2%, P = .69). There was no difference in overall or fungal-free survival. Itraconazole appears to prevent IMI in the subset of patients who tolerate the drug; however, toxicities and poor tolerability limit its success as prophylactic therapy. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Article in Blood Online: Fungal infection in hemato-oncologic patients: better to prevent than to treat? Jan W. van't Wout and Jaap T. van Dissel Blood 2004 103: 1182-1183. [Full Text] [PDF] Related Letter in Blood Online: Elimination of Aspergillus infection in allogeneic stem cell transplant recipients with long-term itraconazole prophylaxis: prevention is better than treatment Drew J. Winston, Christos Emmanouilides, Kathy Bartoni, Gary J. Schiller, Ronald Paquette, Mary C. Territo, Kieren A. Marr, and Michael Boeckh Blood 2004 104: 1581-1582. [Full Text] [PDF] This article has been cited by other articles: M. Michallet and J. I. Ito Approaches to the Management of Invasive Fungal Infections in Hematologic Malignancy and Hematopoietic Cell Transplantation J. Clin. Oncol., July 10, 2009; 27(20): 3398 - 3409. [Abstract] [Full Text] [PDF] G. Maschmeyer Prevention of mould infections J. Antimicrob. Chemother., May 1, 2009; 63(suppl_1): i27 - i30. [Abstract] [Full Text] [PDF] O. A. Cornely, A. Bohme, D. Buchheidt, H. Einsele, W. J. Heinz, M. Karthaus, S. W. Krause, W. Kruger, G. Maschmeyer, O. Penack, et al. Primary prophylaxis of invasive fungal infections in patients with hematologic malignancies. Recommendations of the Infectious Diseases Working Party of the German Society for Haematology and Oncology Haematologica, January 1, 2009; 94(1): 113 - 122. [Abstract] [Full Text] [PDF] 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] B. E. De Pauw and J. P. Donnelly Prophylaxis and Aspergillosis -- Has the Principle Been Proven? N. Engl. J. Med., January 25, 2007; 356(4): 409 - 411. [Full Text] [PDF] D. A. Enoch, H. A. Ludlam, and N. M. Brown Invasive fungal infections: a review of epidemiology and management options. J. Med. Microbiol., July 1, 2006; 55(Pt 7): 809 - 818. [Abstract] [Full Text] [PDF] A. A. Panackal, J. L. Gribskov, J. F. Staab, K. A. 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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. L. Sorror, M. B. Maris, B. M. Sandmaier, B. E. Storer, M. J. Stuart, U. Hegenbart, E. Agura, T. R. Chauncey, J. Leis, M. Pulsipher, et al. Hematopoietic Cell Transplantation After Nonmyeloablative Conditioning for Advanced Chronic Lymphocytic Leukemia J. Clin. Oncol., June 1, 2005; 23(16): 3819 - 3829. [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] Minerva BMJ, March 6, 2004; 328(7439): 592 - 592. [Full Text] [PDF] K. A. Marr, W. Leisenring, F. Crippa, J. T. Slattery, L. Corey, M. Boeckh, and G. B. McDonald Cyclophosphamide metabolism is affected by azole antifungals Blood, February 15, 2004; 103(4): 1557 - 1559. [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]

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