Robenshtok, E., Gafter-Gvili, A., Goldberg, E., Weinberger, M., Yeshurun, M., Leibovici, L., & Paul., M. (2007). Antifungal prophylaxis in cancer patients after chemotherapy or hematopoietic stem-cell transplantation: systematic review and meta-analysis. Journal of Clinical Oncology, 25, 5471–5489.
To determine the effect of antifungal prophylaxis on all-cause mortality, invasive fungal infections (IFIs), and adverse events in patients with cancer treated with chemotherapy or hematopoietic stem cell transplantation (HSCT).
Databases searched were PubMed (January 1966–January 2007) and the Cochrane Library (CENTRAL) (through 2007). Conference proceedings in oncology, hematology, and infectious diseases were also searched. The references of all included trials and reviews were searched for additional studies.
Search keywords were neutropenia, chemotherapy and similar, specific antifungals or antifungal and similar, and prophylaxis and similar.
The authors included studies that were randomized, controlled trials comparing a systemic antifungal drug with placebo, no intervention, or other antifungal agents for prophylaxis of fungal infections in afebrile patients with cancer after chemotherapy or hematopoietic cell transplantation (HCT).
Studies were excluded if they lacked a randomized, controlled design or used empiric or pre-emptive antifungal therapy.
Systemic Antifungals Versus Placebo, No Treatment, or Nonsystemic Antifungals All-Cause Mortality
Subgroup Analysis
Specific Antifungals
Fluconazole Versus IV Amphotericin B
Posaconazole Versus Fluconazole or Itraconazole
Fluconazole Versus Antifungals with Antimold Activity
Other Trials
Current data support the use of fluconazole, itraconazole suspension, or posaconazole for prophylaxis.
Antifungal prophylaxis in patients with solid tumors and autologous HCT is not recommended. Prophylaxis should be administered to patients with acute leukemia during induction chemotherapy and to other patients with high-risk leukemia.