Posaconazole oral suspension primary prophylaxis in acute leukemia and allogeneic stem cell transplant patients: can it be used without measurement of plasma concentration?

Posaconazole oral suspension (PCZ-susp) can display a variable degree of inter and intra-individual absorption. However, there is no agreement on the need of plasma-posaconazole-concentration (PPC) monitoring as a routine practice in patients receiving PCZ-susp. In this prospective, multicenter stud...

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Published in:Medical mycology (Oxford) 2016-07, Vol.54 (5), p.445-458
Main Authors: Girmenia, Corrado, Annino, Luciana, Mariotti, Benedetta, Fanci, Rosa, Minotti, Clara, Spadea, Antonio, Carotti, Alessandra, Piedimonte, Monica, Chierichini, Anna, Cerchiara, Elisabetta, Caselli, Desiree, Cupelli, Luca, Arcioni, Francesco, Bertaina, Alice, Ribersani, Michela, Proia, Anna, Mengarelli, Andrea, Perriello, Vincenzo, Torelli, Giovanni Fernando, Di Gioia, Massimo, Del Principe, Maria Ilaria, Cassetta, Maria Iris, Fallani, Stefania, Novelli, Andrea
Format: Article
Language:English
Subjects:
Administration, Oral
Adolescent
Adult
Aged
Antifungal Agents - administration & dosage
Antifungal Agents - pharmacokinetics
Child
Child, Preschool
Female
Humans
Immunocompromised Host
Leukemia - complications
Male
Middle Aged
Mycoses - prevention & control
Plasma - chemistry
Prospective Studies
Stem Cell Transplantation - adverse effects
Transplantation, Homologous - adverse effects
Triazoles - administration & dosage
Triazoles - pharmacokinetics
Young Adult
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Summary:Posaconazole oral suspension (PCZ-susp) can display a variable degree of inter and intra-individual absorption. However, there is no agreement on the need of plasma-posaconazole-concentration (PPC) monitoring as a routine practice in patients receiving PCZ-susp. In this prospective, multicenter study we evaluated the variability of PPCs in hematologic patients receiving PCZ-susp prophylaxis with the aim to define conditions at different risk of subtherapeutic PPCs. Overall, 103 acute leukemia (AL) patients submitted to intensive chemotherapy (115 courses) and 46 allogeneic stem cell transplant (allo-SCT) recipients (47 courses) receiving PCZ-susp prophylaxis were considered. The adequacy of PPC pattern after the steady state (≥day 7 of treatment) in courses with two or more PPC measurements was defined as follows: inadequate pattern: PPC
ISSN:1369-3786
1460-2709
DOI:10.1093/mmy/myw001