Posaconazole is not superior to itraconazole for fungal prophylaxis in allogeneic blood and marrow transplantation

摘要

I read with interest the article by Sanchez-Ortega ef al. In their discussion, the authors admit several limitations, which significantly discredit the value of the data presented. I note the following additional limitations: (1) The study was done in two different periods of time. (2) There was no sample size calculation. (3) Serum galactomannan was done routinely on all patients twice weekly, which is not the standard practice in many transplant programs. (4) In reading the details of the Methods section, the end point appears to be based on the clinicians' decision to change antifungal therapy 'in a real life setting'; rather than probable/ proven invasive fungal infection. (5) There were more patients who received reduced intensity conditioning in the posaconazole group than the itraconazole group (P = 0.06). Although posaconazole is a reasonable alternative to itraconazole for fungal prophylaxis in allogeneic hematopoietic stem cell transplant recipients, we should not conclude from this study that posaconazole is a better choice than itraconazole.