Cordonnier C, Maury S, Pautas C, Bastié J N, Chehata S, Castaigne S, Kuentz M, Bretagne S, Ribaud P
Hematology Department, Henri Mondor Hospital, Créteil, France.
Bone Marrow Transplant. 2004 May;33(9):943-8. doi: 10.1038/sj.bmt.1704469.
Although the efficacy and safety of voriconazole to treat invasive fungal infections have been demonstrated in prospective trials, its use for secondary prophylaxis to prevent reactivation of these infections remains unknown. Delaying the scheduled treatment of leukemia until complete resolution of fungal infection may have major implications for prognosis. We report 11 leukemic patients with previous aspergillus (n=10) and candida (n=1) infection who received voriconazole 400 mg/day intravenously or orally for between 44 and 245 days. Nine patients were scheduled for allogeneic stem cell transplant, and two for consolidation therapy for acute leukemia. None of the patients had a relapse of fungal infection, and scheduled treatment was delayed only once. Voriconazole was well tolerated, except in one patient who had abnormal liver tests secondary to hepatic graft-versus-host disease, and one who had visual disturbances. This small but homogeneous series indicates that voriconazole may be useful to prevent fungal relapse during at-risk periods in leukemic patients. Prospective trials are warranted to confirm these encouraging results.
尽管伏立康唑治疗侵袭性真菌感染的有效性和安全性已在前瞻性试验中得到证实，但其用于预防这些感染复发的二级预防作用仍不明确。将白血病的预定治疗推迟到真菌感染完全消退可能对预后产生重大影响。我们报告了11例曾感染曲霉菌（n = 10）和念珠菌（n = 1）的白血病患者，他们接受了400毫克/天的伏立康唑静脉或口服治疗，持续44至245天。9例患者计划进行异基因干细胞移植，2例进行急性白血病巩固治疗。所有患者均未出现真菌感染复发，预定治疗仅推迟过一次。伏立康唑耐受性良好，仅有1例因肝移植物抗宿主病导致肝功能检查异常，1例出现视觉障碍。这个规模虽小但同质性较好的系列研究表明，伏立康唑可能有助于预防白血病患者在高危期的真菌复发。有必要进行前瞻性试验来证实这些令人鼓舞的结果。
