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Support Care Cancer. 2011 Jan;19(1):19-26. doi: 10.1007/s00520-009-0783-3. Epub 2009 Dec 3.

Efficacy and safety of intravenous voriconazole and intravenous itraconazole for antifungal prophylaxis in patients with acute myelogenous leukemia or high-risk myelodysplastic syndrome.

Author information

1
Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 428, Houston, TX 77030, USA. gmattiuz@mdanderson.org

Abstract

PURPOSE:

To compare the efficacy and safety of voriconazole with itraconazole as prophylaxis in leukemia patients.

METHODS:

Open-label, randomized study. Patients with acute myelogenous leukemia or high-risk myelodysplastic syndrome undergoing induction chemotherapy or first salvage were eligible. Patients received voriconazole (400 mg intravenous (i.v.) every 12 h for two doses, followed by 300 mg BID) or itraconazole (200 mg i.v. twice daily for 2 days, followed by 200 mg i.v. daily).

RESULTS:

A total of 127 patients were enrolled. Four were excluded because they did not receive study drug (n=3) or received two antifungal agents during the first week on study (n =1), leaving 123 patients for analysis. None of the 71 patients receiving voriconazole developed proven or probable invasive fungal infection, compared to two (4%) of the 52 patients receiving itraconazole (P=0.17). Drug discontinuation because of adverse events occurred in 15 patients (21%) receiving voriconazole and six (11%) receiving itraconazole (P=0.23).

CONCLUSIONS:

Voriconazole is a good alternative for prophylaxis in patients with leukemia. Elevated baseline bilirubin levels were associated with a higher risk of side effects in patients receiving i.v. voriconazole or i.v. itraconazole. Monitoring of liver function and drug levels should be considered for some patients.

PMID:
19956980
DOI:
10.1007/s00520-009-0783-3
[Indexed for MEDLINE]

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