Prophylaxis of fungal infections with itraconazole during remission-induction therapy

Area of Science:

• Mycology
• Hematology Oncology
• Infectious Diseases

Background:

• Deep fungal infections pose a significant risk to patients undergoing treatment for acute leukemias and malignant lymphomas.
• Current empirical treatment with intravenous amphotericin B is associated with considerable toxicity, increasing patient morbidity and mortality.
• Diagnostic challenges often necessitate empirical treatment strategies.

Purpose of the Study:

• To evaluate the prophylactic efficacy of oral itraconazole against deep fungal infections in patients with hematological malignancies.
• To assess the safety and effectiveness of itraconazole as a preventative measure compared to placebo.
• To investigate itraconazole's role in managing candidosis and aspergillosis in immunocompromised individuals.

Main Methods:

• A large, multi-centre, randomised, double-blind, prospective trial was conducted in the U.K.
• Oral itraconazole was administered for prophylaxis against deep fungal infections.
• The study compared itraconazole's efficacy against a placebo in patients undergoing treatment for hematological malignancies.

Main Results:

• Retrospective studies indicate significantly fewer deep fungal infections in patients receiving itraconazole.
• Oral itraconazole has demonstrated successful treatment of fungal infections resistant to intravenous amphotericin B.
• Pharmacokinetic data confirm therapeutic plasma levels, although with notable inter- and intra-patient variability.

Conclusions:

• Oral itraconazole shows promise as a safe and effective prophylactic agent against deep fungal infections in immunocompromised patients.
• Further investigation through the prospective trial is crucial to confirm its prophylactic efficacy in hematological malignancies.
• Itraconazole may offer a viable alternative to more toxic antifungal therapies, potentially improving patient outcomes.