voriconazole / Generic mfg. - LARVOL DELTA

Time to re-evaluate combination antifungal therapy for invasive aspergillosis and other invasive mycoses. (PubMed, Lancet Infect Dis) - "A previous randomised controlled trial of combination therapy with voriconazole plus anidulafungin versus voriconazole alone showed that the combination was safe and associated with a clinically significant reduction in all-cause mortality that, however, failed narrowly to meet conventional levels of significance. In this Personal View, we argue against a binary, negative interpretation of these results, and that the totality of the laboratory and clinical evidence favours a triazole-echinocandin combination for the treatment of immunocompromised patients with proven or probable invasive aspergillosis. Renewed efforts are needed to optimise and evaluate other combination approaches for aspergillosis and other life-threatening invasive fungal diseases as a means by which to mitigate antifungal resistance, maximise and prolong the utility of old and new agents, and drive down mortality."

Journal • Review • Dermatology • Infectious Disease • Pulmonary Disease • Respiratory Diseases

Front Line Ibrutinib Without Corticosteroids for Newly Diagnosed Chronic Graft-versus-Host Disease (clinicaltrials.gov) - P2 | N=10 | Completed | Sponsor: National Cancer Institute (NCI) | Active, not recruiting ➔ Completed

Trial completion • Chronic Graft versus Host Disease • Graft versus Host Disease • Immunology

Eruptive lentigines in a child receiving voriconazole after bone marrow transplant. (PubMed, Indian J Dermatol Venereol Leprol) - No abstract available

Journal • Bone Marrow Transplantation • Transplantation

PROGNOSIS OF INVASIVE ASPERGILLOSIS AFTER ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION (EBMT 2026) - "First-line treatments were mainly liposomal amphotericin B and voriconazole. Despite recent therapeutic advances, IA remains associated with substantial long-term mortality in allo-HSCT recipients. Although part of this mortality is directly caused by IA, the infection mainly reflects clinical frailty characterized by profound immunosuppression (e.g. systemic corticosteroid therapy, prolonged neutropenia) or relapse of the underlying hematological malignancy."

Acute Graft versus Host Disease • Bone Marrow Transplantation • Graft versus Host Disease • Hematological Malignancies • Immunology • Infectious Disease • Neutropenia • Respiratory Diseases • Transplantation

PERSISTING FEVER AFTER ALLOGENEIC STEM CELL TRANSPLANTATION: A CASE REPORT OF A RARE INFECTION WITH LOMENTOSPORA PROLIFICANS (EBMT 2026) - "Cytoreductive therapy with hydroxyurea was initiated immediately after diagnosis, with no other prior antineoplastic treatment administered. Conditioning with fludarabine, thiotepa, and melphalan was started 7 months after the initial diagnosis...The patient received an HLA-identical unrelated male donor peripheral blood stem cell graft, with graft-versus-host disease prophylaxis comprising cyclosporine, mycophenolate mofetil, and anti-thymocyte globulin (ATG)...On day −3, the patient developed febrile neutropenia and broad-spectrum antibiotic treatment (piperacillin/tazobactam) was initiated. Recurrent fever on day +1 led to escalation to meropenem and a switch from fluconazole to posaconazole; blood cultures remained negative.Under these measures, the fever persisted...On day +11, increasing somnolence, pathological breathing pattern, and new oxygen requirement prompted sampling of peripheral and central blood cultures and empiric addition of linezolid and..."

Case report • Clinical • Bone Marrow Transplantation • Chronic Myelomonocytic Leukemia • Febrile Neutropenia • Graft versus Host Disease • Hematological Disorders • Hematological Malignancies • Immunology • Infectious Disease • Leukemia • Neutropenia • Respiratory Diseases • Septic Shock • Transplantation • ASXL1 • NRAS • RUNX1 • SETBP1 • SRSF2

POTENTIAL FOR PHARMACOGENOMICS TO IMPROVE MEDICATION SAFETY AND EFFICACY IN AUSTRALIAN HAEMATOPOIETIC STEM CELL TRANSPLANT PATIENTS (EBMT 2026) - "Paired supportive care medications included allopurinol, sertraline, omeprazole, pantoprazole, voriconazole, ondansetron, tramadol, tacrolimus, flucloxacillin, carbamazepine and amikacin. We have demonstrated the prevalence of clinically relevant high-risk PGx phenotypes in a diverse paediatric oncology cohort. Many supportive care medications prescribed for paediatric HSCT patients are likely to be affected, with high prescribing rates observed for some medications with available PGx prescribing guidelines. These results highlight the potential for PGx guided prescribing to improve medication efficacy and reduce toxicity in a paediatric HSCT setting."

Biomarker • Clinical • Bone Marrow Transplantation • Transplantation • ABCG2 • CYP2C19 • CYP3A5 • HLA-B • NUDT15

A RETROSPECTIVE ANALYSIS OF THE CLINICAL CHARACTERISTICS, RISK FACTORS, AND PROGNOSIS OF FUSARIUM INFECTION IN HEMATOLOGIC PATIENTS BEFORE AND AFTER HEMATOPOIETIC STEM CELL TRANSPLANTATION (EBMT 2026) - "Myeloablative regimens included: busulfan-based (n=37, 61.67%), TBI-based (n=22, 36.67%), and melphalan-based (n=1, 1.67%).Pathogen distribution: Fusarium solani species complex (n=27, 45%), Fusarium fujikuroi species complex (n=21, 35%), Fusarium oxysporum species complex (n=5, 8.33%), Fusarium verticillioides (n=4, 6.67%), Fusarium graminearum (n=2, 3.33%), and Fusarium falciforme (n=1, 1.67%)...Among these, two underwent antifungal susceptibility testing, both showing sensitivity to voriconazole and amphotericin B.Regarding infection timing: 11 patients (18.33%) were infected before transplant conditioning, 7 (11.67%) during conditioning, 18 (30%) in the early post-transplant period (within 100 days after transplantation), and 24 (40%) in the late post-transplant period (beyond 100 days after transplantation)... Bridging hematopoietic stem cell transplantation is an extremely high-risk factor for invasive fusariosis, with early infection onset and poor prognosis...."

Retrospective data • Acute Lymphocytic Leukemia • Acute Myelogenous Leukemia • Agranulocytosis • Aplastic Anemia • B Cell Lymphoma • Bone Marrow Transplantation • Chronic Graft versus Host Disease • CNS Disorders • Graft versus Host Disease • Granulocytopenia • Hematological Disorders • Hematological Malignancies • High-grade B-cell lymphoma • Immunology • Infectious Disease • Leukemia • Lymphoblastic Lymphoma • Lymphoma • Myelodysplastic Syndrome • Non-Hodgkin’s Lymphoma • Pneumonia • Respiratory Diseases • Transplantation • Transplantation Associated Thrombotic Microangiopathy

SUCCESSFUL ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION FOR NEWLY DIAGNOSED AND RELAPSED/REFRACTORY ACUTE MYELOBLASTIC LEUKEMIA FOLLOWING A HIGHLY EFFICIENT REGIMEN, FLAG-MITOXANTRONE WITH LOW-DOSE 7 DAYS VENETOCLAX (EBMT 2026) - "Background: FLAG (G-CSF, Fludarabine, Cytarabine) combined with either Idarubicin (Ida) or Mitoxantrone (Mitox) are effective and well tolerated in newly diagnosed (ND) or relapsed/refractory (R/R) Acute Myeloblastic Leukemia (AML)(Burnett et al...FLAG-Mitox +Ven combined G-CSF (5μg/kg/d) on d1-7, Fludarabine (30mg/m2/d IV), and Cytarabine (1.5g/m2/d IV) on d2-5, Mitox (12mg/m2/d IV) d2,4 and Ven (100mg PO daily) given with voriconazole d2-8...Among the 50 R/R pts, first induction therapy consisted of 7+3 regimen in 32 pts (64%), FLAG-Ida in 15 pts (30%) and 5-Azacytidine+Ven in 3 pts (6%)... FLAG–Mitox+Ven (7d) is a highly-effective and well-tolerated for remission induction and MRD negativity in ND and R/R AML pts. High survival outcomes were demonstrated across ELN 2022 risk groups in ND AML pts. This regimen is also an effective bridge to AHSCT."

Acute Myelogenous Leukemia • Bone Marrow Transplantation • Hematological Malignancies • Infectious Disease • Leukemia • Pneumonia • Respiratory Diseases • Transplantation • FLT3

POPULATION PHARMACOKINETICS OF CYCLOSPORINE A IN PATIENTS UNDERGOING ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION RECEIVING POST-TRANSPLANTATION CYCLOPHOSPHAMIDE FOR GRAFT-VERSUS-HOST DISEASE PROPHYLAXIS (EBMT 2026) - "Although CsA PK has been extensively studied in traditional methotrexate-based protocols, data describing its disposition specifically within the context of PTCy are limited...Daily hematocrit (HCT) levels and concomitant administration of azole antifungals (fluconazole, voriconazole, posaconazole) were modeled as time-varying regressors to accurately capture the dynamic inhibition effect on clearance (CL)... This study characterizes CsA pharmacokinetics specifically in the PTCy setting, demonstrating that age, hematocrit levels and voriconazole co-administration are major determinants of exposure. Integrating this model into TDM software could facilitate precision dosing to improve clinical outcomes."

Clinical • PK/PD data • Post-transplantation • Bone Marrow Transplantation • Graft versus Host Disease • Immunology • Transplantation

OPEN WIDE: EXPLORING SALIVA AS A NON-INVASIVE TOOL FOR POSACONAZOLE LEVELS IN CHILDREN (EBMT 2026) - "This is the first prospective study assessing salivary detection of posaconazole in children. Our findings indicate that saliva sampling is unsuitable for posaconazole TDM in immunocompromised children. The minimal detection is possibly related to its high protein binding (>98%) similar to itraconazole and in contrast to voriconazole (~58%) and fluconazole (~10%), which have demonstrated reliable salivary penetration."

Clinical • Non-invasive • Infectious Disease • Mucositis • Stomatitis

CLINICAL, LABORATORY, AND PHARMACOLOGICAL FACTORS INFLUENCING CALCINEURIN INHIBITOR PLASMA LEVELS IN ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANT RECIPIENTS (EBMT 2026) - "Background: Calcineurin inhibitors (CNIs), particularly cyclosporine (CSA) and tacrolimus (TAC), are essential for graft-versus-host disease (GVHD) prophylaxis after allogeneic hematopoietic cell transplantation (HCT)...Separate linear mixed-effects models (LME) were developed for CSA and TAC to evaluate associations between plasma levels and key covariates: age, sex, race, body weight, creatinine, AST/TGO, ALT/TGP, albumin, hematocrit, antifungal exposure (fluconazole, micafungin, voriconazole), and day since CNI initiation... CNI plasma levels are influenced by drug-specific patterns involving clinical, laboratory, and pharmacological factors. CSA exposure was primarily shaped by weight and hematocrit, whereas TAC demonstrated additional associations with age, sex, hepatic function, and micafungin use, reflecting its more complex metabolism. These findings suggest that part of the variability in CNI levels is predictable and occasionally modifiable, supporting refined,..."

Clinical • Bone Marrow Transplantation • Graft versus Host Disease • Immunology • Transplantation

SUBTHERAPEUTIC CYCLOSPORINE CONCENTRATIONS DESPITE STANDARD DOSING IN HSCT PRACTICE (EBMT 2026) - "(p>0.05)Drug–drug interactions were identified in 21 cases receiving concurrent antifungal therapy (6 on voriconazole, 12 on isavuconazole, 3 on fluconazole)...Only 1 case (8.3%) with isavuconazole met target level.Cyclophosphamide was included in the conditioning regimen for 96 patients; the remaining four cases involved second or later transplants, limiting the ability to assess the contribution of cyclophosphamide to cyclosporine clearance... The standard cyclosporine dose of 3 mg/kg/day frequently fails to achieve target therapeutic concentrations in HSCT patients. Despite a wide distribution of BMI in the cohort, no clear association between body size and achieving therapeutic levels was observed when dosing was based on lower body weight. This finding suggests that using lower body weight for dosing is appropriate."

Bone Marrow Transplantation • Graft versus Host Disease • Immunology • Obesity

CONDITIONING WITH FLUDARABINE, CYTARABINE, VENETOCLAX, ETOPOSIDE FOR ALLOGENEIC STEM CELL TRANSPLANT IN PATIENTS WITH ACTIVE ACUTE MYELOID LEUKEMIA (EBMT 2026) - "FLAVER conditioning regimen consisting of Fludarabine 30mg/m2 , Cytarabine 1500mg/m2 , Tab Venetoclax 100 mg OD with Tab Voriconazole 200 mg BD on Days -8,-7,-6,-5,-4 with alkylating agent backbone consisting of Busulfan 3.2mg/kg on D-3,-2 and Cyclophosphamide 2000mg/m2 on D-2 to D-1...GVHD prophylaxis consisted of Methotrexate 15 mg/m2 on D+1 and 10 mg/m2 on days +3,+6,+11 cyclosporine A (from day -1 with tapering from day +100, target concentration 200-400 mcg/l), and mycophenolate mofetil 1 g/d (days -8 to +30). All patients received GCSF and Plerixafor mobilized peripheral blood stem cells... In this single center experience, FLAVER-SCT demonstrated encouraging remission rates and manageable toxicity in patients with relapsed and active AML, a population historically associated with poor prognosis. The high CR/CRp rate and rapid neutrophil engraftment suggests potent disease control. Despite frequent toxicities acute mortality remained acceptable with durable..."

Clinical • Acute Graft versus Host Disease • Acute Myelogenous Leukemia • Cardiovascular • Graft versus Host Disease • Hematological Malignancies • Hepatology • Immunology • Leukemia • Transplantation • FLT3

ANTIFUNGAL PROPHYLAXIS PATTERNS AND INVASIVE FUNGAL INFECTIONS OUTCOMES IN PAEDIATRIC ALLOGENIC HCT: A MULTICENTRE COHORT STUDY (EBMT 2026) - "Choice of antifungal prophylaxis was classified as non–mould-active (fluconazole), mould-active (including micafungin, liposomal amphotericin B, voriconazole and posaconazole), or mixed (both non-mould active and mould active agents). Antifungal prophylaxis in paediatric allogenic HCT was strongly risk-adapted, with increased mould-active use in patients with prior history of IFI. IFIs occurred across all prophylaxis strategies, with all proven IFIs occurring in patients on fluconazole monotherapy. Most IFIs arose post-engraftment, highlighting the need for consistent, risk-based escalation to mould-active prophylaxis in immunosuppressed children."

Clinical • Infectious Disease • Pediatrics

Unveiling the impact of atmospheric temperature on antifungal resistance and virulence factors in Candida spp. isolated from forest ecosystem. (PubMed, Microb Pathog) - "Antifungal susceptibility was assessed using the Kirby-Bauer disk diffusion method, testing the efficacy of amphotericin B, fluconazole, ketoconazole, and voriconazole. The stability of phospholipase and esterase activity indicates that not all virulence factors are temperature-sensitive, emphasizing the complexity of fungal adaptation. This study highlights the critical need for further research on the influence of climate change on fungal pathogenicity and treatment efficacy."

Journal • Infectious Disease

Disseminated Lomentospora prolificans infection in a patient with neutropenia treated with ipilimumab and nivolumab. (PubMed, BMJ Case Rep) - "The neutrophil count only recovered once oral prednisolone was commenced, indicating a haematological irAE. A restaging Positron Emission Tomography scan revealed intramuscular ring-enhancing collections throughout his body, one of which was aspirated and cultured the fungus Lomentospora prolificans He was treated with voriconazole plus terbinafine, both of which were later substituted with olorofim due to a voriconazole-induced rash. After 4 months, the collections had resolved on repeat imaging, and olorofim was ceased due to transaminitis. This case highlights neutropenia as a lesser-known adverse effect of immunotherapy and raises awareness about L. prolificans infection."

Journal • Febrile Neutropenia • Hematological Disorders • Infectious Disease • Melanoma • Neutropenia • Oncology • Solid Tumor

Uncommon clinical presentations and diagnostic difficulties of antiphospholipid syndrome associated with cryptococcal meningitis: A case study. (PubMed, Med Mycol Case Rep) - "Consequently, an individualized regimen comprising voriconazole and 5-fluorocytosine (5-FC) was initiated, resulting in significant clinical improvement. This case underscores that CM is a serious opportunistic infection in patients undergoing immunosuppression for APS, highlighting the need for vigilant monitoring and tailored antifungal strategies for multi-organ dysfunction."

Journal • Cardiovascular • CNS Disorders • Genetic Disorders • Hematological Disorders • Hepatology • Immunology • Infectious Disease • Liver Failure • Obstetrics • Thrombosis

Pharmacovigilance insights: safety profiles of antifungal agents for invasive aspergillosis. (PubMed, Front Pharmacol) - "The safety profiles of FDA-approved antifungal agents, triazoles (Voriconazole, Posaconazole, Isavuconazole), polyenes (Amphotericin B), and echinocandins (Caspofungin), are not yet fully characterized in real-world settings. Amphotericin B and Caspofungin are associated with severe renal/hepatic toxicities and higher mortality, while Isavuconazole and Posaconazole may offer safer alternatives with delayed AE onset. Clinicians should prioritize drug-specific risks when tailoring treatment for IA patients."

Adverse events • Journal • Cholestasis • Hepatology • Ocular Inflammation • Ophthalmology • Optic Neuritis • Pain • Pulmonary Disease • Renal Disease • Respiratory Diseases

Emerging Applications of Triazole Antifungal Drugs. (PubMed, Int J Mol Sci) - "The clinical utility of key antifungal agents, namely, posaconazole, isavuconazole, and voriconazole, is critically evaluated. We also examine the potential role of emerging agents such as opelconazole, which enables targeted pulmonary delivery and prolonged epithelial retention, representing a promising approach to IFI prevention. Drug-specific considerations, including pharmacokinetics, drug-drug interactions, toxicity profiles, and cost-effectiveness, are analyzed in the context of clinical decision-making. Finally, we emphasize the importance of tailoring antifungal strategies based on leukemia subtype, immunosuppressive status, and individual patient factors to optimize outcomes and support antifungal stewardship in hematologic malignancies."

Journal • Review • Acute Myelogenous Leukemia • Chemotherapy-Induced Neutropenia • Hematological Disorders • Hematological Malignancies • Infectious Disease • Leukemia • Neutropenia • Oncology

Isavuconazole in the treatment of acute invasive fungal sinusitis: two case reports and literature review. (PubMed, Front Med (Lausanne)) - "Literature comparisons further validate these findings, demonstrating that the efficacy of the new triazole drug isavuconazole in treating invasive aspergillosis and mucormycosis significantly surpasses that of amphotericin B, with efficacy comparable to voriconazole (p < 0.05). These results provide valuable guidance for clinical medication decisions."

Journal • Infectious Disease • Otorhinolaryngology • Pulmonary Disease • Respiratory Diseases • Sinusitis

Concurrent Administration of Triazoles with Chemotherapeutic and/or Immunosuppressant Agents Known to Have Moderate-to-Severe Drug-Drug Interactions in Patients with Hematologic Malignancies Hospitalized for Invasive Aspergillosis. (PubMed, Mycopathologia) - "Concurrent administration of triazole with potential PK interactions with CT or IS agents occurred in most HM patients admitted for IA. Choosing alternative antifungals, therapeutic drug monitoring of triazoles or selective ISs, and dosage adjustment of CT/IS agents may mitigate the risk of adverse DDIs. New antifungal agents without serious DDIs with CT and/or IS agents are needed for treatment of IA to reduce the risk of serious adverse events."

Journal • Retrospective data • Hematological Disorders • Hematological Malignancies • Oncology • Pulmonary Disease • Respiratory Diseases

Characteristics of individual cyp51A SNPs and combinations thereof impacting the azole phenotype in TR34-mediated resistance genotypes of Aspergillus fumigatus. (PubMed, Antimicrob Agents Chemother) - "The MICs of all four azoles against the mutated cyp51A strains, which harbored combination mutations, were higher than those of the wild type, with highly elevated MICs of itraconazole, voriconazole, and isavuconazole. Genotypes TR34/L98H/T289A/I364V/G448S mutant showed a consistent phenotype to the clinical strains, which are highly resistant to voriconazole but susceptible to itraconazole. In this study, we show that molecular dynamics simulations of amino acid substitutions in the cyp51A gene correlate to the structure-function relationship of in vitro phenotype."

Journal

Antifungal treatment strategies in intensive care unit patients. (PubMed, Eur J Clin Invest) - "Optimizing antifungal stewardship through individualized therapy and early diagnosis remains essential to improve outcomes in this high-risk population."

Journal • Review • Candidiasis • Critical care • Human Immunodeficiency Virus • Infectious Disease • Pneumonia • Pulmonary Disease • Respiratory Diseases

Pathogen spectrum and management strategies for opportunistic infections in lung cancer in the immunotherapy era: recent advances from fungi to mycobacteria. (PubMed, Am J Cancer Res) - "High-risk features include absolute lymphocyte count <500/µL, corticosteroids ≥20 mg prednisone-equivalent for ≥4 weeks, airway obstruction, prior TB, chronic obstructive pulmonary disease/interstitial lung disease (ILD), and recent broad-spectrum antibiotics...Prophylaxis with TMP-SMX is recommended for high-risk patients; voriconazole (or isavuconazole) is first-line for IPA with attention to drug-drug interactions; TB/NTM regimens require coordination with anticancer therapy, especially where rifamycins interact with TKIs. Vaccination (influenza, pneumococcus, zoster) and antimicrobial stewardship are essential. Future work should validate risk scores prospectively and clarify microbiome-immunotherapy-infection relationships."

IO biomarker • Journal • Review • Bronchiectasis • Chronic Obstructive Pulmonary Disease • Herpes Zoster • Immunology • Infectious Disease • Influenza • Interstitial Lung Disease • Lung Cancer • Nontuberculous Mycobacterial Disease • Oncology • Pneumococcal Infections • Pneumonia • Pulmonary Disease • Respiratory Diseases • Solid Tumor • Tuberculosis

Cutaneous Alternariosis Caused by Alternaria infectoria: A Case Report in Kidney Transplant Recipient and Literature Review. (PubMed, J Fungi (Basel)) - "Treatment included systemic azole therapy (voriconazole followed by isavuconazole) and surgical excision, resulting in resolution without recurrence. This case highlights the importance of early recognition of alternariosis in transplant recipients. Successful management typically requires combined surgical and systemic antifungal therapy, with careful monitoring of drug interactions and immunosuppressive levels to prevent toxicity or rejection."

Journal • Dermatology • Hematological Disorders • Infectious Disease • Mood Disorders • Neutropenia • Oncology • Solid Organ Transplantation • Transplantation