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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 (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 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 Related Article in Blood Online Related Letter in Blood Online Social Bookmarking                   What's this? Submitted July 25, 2003 Accepted September 9, 2003 Itraconazole versus fuconazole for prevention of fungal infections in allogeneic stem cell transplant patients Kieren A Marr*, Fulvio Crippa, Wendy Leisenring, Maggie Hoyle, Michael Boeckh, S A Balajee, W G Nichols, Benjamin Musher, and Lawrence Corey Program in Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA Program in Clinical Statistics, Fred Hutchinson Cancer Research Center, Seattle, WA, USA Department of Laboratory Medicine, University of Washington, Seattle, WA, USA Department of Medicine, San Raffale Hospital and University, Milan, Italy Program in Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, WA, USA * Corresponding author; email: kmarr{at}fhcrc.org. Prophylactic fluconazole prevents candidiasis, however this drug has no activity against moulds. We performed a randomized trial to determine if prophylactic itraconazole prevents invasive mould infections (IMI). Three-hundred and four allogeneic SCT patients were randomized to receive fluconazole (400 mg/day) or itraconazole (oral solution 2.5 mg/kg three times daily, or IV 200 mg daily) for 180 days after SCT, or until 4 weeks after discontinuation of graft vs. 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 due to toxicities or GI intolerance (36% vs. 16%, p<0.001). Intent-to-treat analysis demonstrated no difference in the incidence of IFI during the intended study period (fluconazole 16% vs. itraconazole 13%, p=0.46); however, fewer itraconazole patients developed IFI on-treatment (fluconazole 15% vs. itraconazole 7%, p=0.03). Itraconazole provided better protection against IMI (fluconazole 12% vs. itraconazole 5%, p=0.03), but similar protection against candidiasis (3% vs. 2%, p=0.69). 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: 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. 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