***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: ABSTRACT Invasive fungal infection remains the most common cause of infectious death in acute leukemia . In this open-label , r and omized study , we compared the efficacy and safety of caspofungin with that of intravenous itraconazole for antifungal prophylaxis in patients undergoing induction chemotherapy for acute myelogenous leukemia or myelodysplastic syndrome . Of 200 patients , 192 were evaluable for efficacy ( 86 for itraconazole , 106 for caspofungin ) . Duration of prophylaxis ( median , 21 days [ range , 1 to 38 days ] ) , demographics , and prognostic factors were similar in both groups . Ninety-nine patients completed antifungal prophylaxis without developing fungal infection ( 44 [ 51 % ] with itraconazole , 55 [ 52 % ] with caspofungin ) . Twelve patients developed documented invasive fungal infections , five in the itraconazole group ( four with c and idemia and one with Aspergillus pneumonia ) , and seven in the caspofungin group ( two with c and idemia , two with disseminated trichosporon species , two with Aspergillus pneumonia , and one with disseminated Fusarium spp ) . Two patients in the itraconazole group and four in the caspofungin group died of fungal infection ( P = 0.57 ) . Grade 3 to 4 adverse event rates were comparable between groups ; the most common event in both was reversible hyperbilirubinemia . No evidence of cardiovascular toxicity from intravenous itraconazole was noted among patients older than 60 . In conclusion , intravenous itraconazole and caspofungin provided similar protection against invasive fungal infection during induction chemotherapy , and both drugs were well tolerated Invasive fungal infection ( IFI ) is a serious threat after allogeneic hematopoietic cell transplant ( HCT ) . This multicenter , r and omized , double-blind trial compared fluconazole ( N = 295 ) versus voriconazole ( N = 305 ) for the prevention of IFI in the context of a structured fungal screening program . Patients undergoing myeloablative allogeneic HCT were r and omized before HCT to receive study drugs for 100 days , or for 180 days in higher-risk patients . Serum galactomannan was assayed twice weekly for 60 days , then at least weekly until day 100 . Positive galactomannan or suggestive signs triggered m and atory evaluation for IFI . The primary endpoint was freedom from IFI or death ( fungal-free survival ; FFS ) at 180 days . Despite trends to fewer IFIs ( 7.3 % vs 11.2 % ; P = .12 ) , Aspergillus infections ( 9 vs 17 ; P = .09 ) , and less frequent empiric antifungal therapy ( 24.1 % vs 30.2 % , P = .11 ) with voriconazole , FFS rates ( 75 % vs 78 % ; P = .49 ) at 180 days were similar with fluconazole and voriconazole , respectively . Relapse-free and overall survival and the incidence of severe adverse events were also similar . This study demonstrates that in the context of intensive monitoring and structured empiric antifungal therapy , 6-month FFS and overall survival did not differ in allogeneic HCT recipients given prophylactic fluconazole or voriconazole . This trial was registered at www . clinical trials.gov as NCT00075803 To evaluate the efficacy of itraconazole capsules in prophylaxis for fungal infections in neutropenic patients , we conducted a prospect i ve , double-blind , placebo-controlled , r and omized trial . Patients with hematologic malignancies or those who received autologous bone marrow transplants were assigned either a regimen of itraconazole ( 100 mg orally twice daily ; n=104 ) or of placebo ( n=106 ) . Overall , fungal infections ( superficial or systemic ) occurred more frequently in the placebo group ( 15 % vs. 6 % ; P=.03 ) . There were no differences in the empirical use of amphotericin B or systemic fungal infections . Among patients with neutropenia that was profound ( < 100 neutrophils/mm3 ) and prolonged ( for at least 7 days ) , those receiving itraconazole used less empirical amphotericin B ( 22 % vs. 61 % ; P=.0001 ) and developed fewer systemic fungal infections ( 6 % vs. 19 % ; P=.04 ) . For patients with profound and prolonged neutropenia , itraconazole capsules at the dosage of 100 mg every 12 h reduce the frequency of systemic fungal infections and the use of empirical amphotericin Fungal infections are a major problem in patients with hematologic malignancy . Attempts to reduce their frequency with antifungal agents have not been successful . A double-blind , controlled , single-center trial was conducted with 96 consecutive patients undergoing 154 episodes of chemotherapy . Patients received 400 mg of fluconazole or placebo until bone marrow recovery or initiation of intravenous amphotericin B infusions . End points were  amphotericin B use , fungal infection , stable neutrophil count > 0.5 x 10(9)/L , toxicity precluding further fluconazole use , and death . By Kaplan-Meier estimation , the time to initiation of amphotericin B therapy was shorter in 76 patients treated with placebo than in 75 treated with fluconazole ( P = .003 ) . Also , fluconazole reduced the number of febrile days by 20 % ( P = .002 ) and prevented oropharyngeal c and idiasis ( 1/75 vs. 9/76 , P = .018 ) . The frequency of deep mycoses ( 8/76 vs. 8/75 ) and outcome were unaffected . Fluconazole did not have a favorable effect on infection-related health care costs and was associated with prolonged severe neutropenia ( P = .01 ) Liposomal amphotericin ( AmBisome ) 2 mg/kg three times weekly was compared with placebo as prophylaxis against fungal infection in patients undergoing chemotherapy or bone marrow transplantation ( BMT ) for haematological malignancies . Prophylaxis began on day 1 of chemotherapy and continued until neutrophils regenerated or infection was suspected . Of 161 evaluable patients , 74 received AmBisome  and 87 received placebo .  Proven fungal infections developed in no patients on AmBisome and in three on placebo ( 3.4 % ) ( P = NS ) . Suspected fungal infections requiring intervention with systemic antifungal therapy  ( usually amphotericin B ) occurred in 31 patients on AmBisome ( 42 % ) and in 40 on placebo ( 46 % ) ( P = NS ) . Suspected deep-seated infections developed in 21 ( 28.3 % ) and 31 ( 35.6 % ) patients , respectively ( P = NS ) . Time to develop a suspected or proven deep-seated infection showed a trend in favour of AmBisome ( P = 0.11 ) . Fifty patients had fungal colonisation ( 48 with C and ida spp , two with Aspergillus spp ) of at least one body site during prophylaxis ; 15 patients while receiving AmBisome ( 20 % ) and 35 while on placebo ( 40 % ) ( P < 0.01 ) . time to colonisation was significantly delayed in the group receiving ambisome ( P < 0.05 ) . treatment-related toxicity was modest and no additional toxicity was observed in patients receiving ambisome . ambisome 2 mg/kg three times weekly is safe and reduces fungal colonisation in patients receiving intensive chemotherapy or bmt . however , despite encouraging trends , prophylactic ambisome did not lead to a significant reduction in fungal infection or in requirement for systemic antifungal therapy Mixed treatment comparison ( MTC ) meta- analysis is a generalization of st and ard pairwise meta- analysis for A vs B trials , to data structures that include , for example , A vs B , B vs C , and A vs C trials . There are two roles for MTC : one is to strengthen inference concerning the relative efficacy of two treatments , by including both ' direct ' and ' indirect ' comparisons . The other is to facilitate simultaneous inference regarding all treatments , in order for example to select the best treatment . In this paper , we present a range of Bayesian hierarchical models using the Markov chain Monte Carlo software WinBUGS . These are multivariate r and om effects models that allow for variation in true treatment effects across trials . We consider models where the between-trials variance is homogeneous across treatment comparisons as well as heterogeneous variance models . We also compare models with fixed ( unconstrained ) baseline study effects with models with r and om baselines drawn from a common distribution . These models are applied to an illustrative data set and posterior parameter distributions are compared . We discuss model critique and model selection , illustrating the role of Bayesian deviance analysis , and node-based model criticism . The assumptions underlying the MTC models and their parameterization are also discussed Invasive fungal infection is a problem in patients undergoing bone marrow transplantation ( BMT ) . To determine if a liposomal formulation of amphotericin B ( Ambisome ) is safe and can prevent fungal infection we performed a placebo controlled double-blind r and omized prophylactic trial . Study drug was administered from when neutrophil count had decreased to < 0.5 x 10(9)/l and was continued until neutrophils recovered to this level or an infection or toxicity end-point was reached . Thirty-six patients received 1 mg/kg/day of ambisome and 40 patients received placebo daily . There were no statistical differences in characteristics or clinical course between the two groups . Fungal colonization decreased in the ambisome group while it increased in the placebo group . By the end of prophylaxis 8 of 24 ( 33 % ) patients receiving ambisome were colonized compared with 18 of 29 ( 62 % ) placebo patients ( p = 0.05 ) . Five and 7 patients on ambisome  or placebo , respectively , were withdrawn due to a presumed fungal infection ( NS ) . There was no statistical reduction of autopsy-proven fungal infection . Proven fungal infection occurred in one patient receiving ambisome ( C. guillermondi ) compared with three patients receiving placebo ( C. guillermondi , 2 ; C. albicans , 1 ) . Ambisome was well tolerated at the dose of 1 mg/kg/day but in three patients allergic reactions were observed OBJECTIVES This trial studied the efficacy and safety of itraconazole and fluconazole in the prevention of invasive fungal infections in neutropenic patients with haematological malignancies . PATIENTS AND METHODS An 8 week , open-label , r and omized , parallel-group , multicentre trial comparing itraconazole oral solution ( 2.5 mg/kg twice daily ; N=248 ) with fluconazole oral solution or capsules ( 400 mg daily ; N=246 ) in 494 patients with anticipated profound neutropenia ( i.e. neutrophil count expected to be < 500 cells/mm3 for at least 10 days ) from tertiary care centres . RESULTS Invasive fungal infections were reported for 4 out of 248 patients ( 1.6 % ) in the itraconazole group and 5 out of 246 patients ( 2.0 % ) in the fluconazole group . Invasive Aspergillus infections were proven for 2 out of 248 patients ( 0.8 % ) in the itraconazole group and 3 out of 246 patients ( 1.2 % ) in the fluconazole group . For both the ITT and profoundly neutropenic population s , no differences were detected between treatment groups in proven or suspected invasive fungal infections or other endpoints . The mortality rates owing to proven invasive fungal infections were 2 out of 248 patients ( 0.8 % ) for the itraconazole group and 3 out of 246 patients ( 1.2 % ) for the fluconazole group . There was also no difference between treatment groups in the number of patients who recovered from neutropenia or in the duration of neutropenia . More discontinuation of drug intake owing to nausea and more hypokalaemia occurred in the itraconazole group , other adverse events and the total number of adverse events were similar in both groups . CONCLUSIONS In this study there were no differences in the efficacy and safety of itraconazole and fluconazole prophylaxis in neutropenic patients with haematological malignancies Purpose To compare the efficacy and safety of voriconazole with itraconazole as prophylaxis in leukemia patients . Methods Open-label , r and omized study . Patients with acute myelogenous leukemia or high-risk myelodysplastic syndrome undergoing induction chemotherapy or first salvage were eligible . Patients received voriconazole ( 400 mg intravenous ( IV ) every 12 h for two doses , followed by 300 mg BID ) or itraconazole ( 200 mg IV twice daily for 2 days , followed by 200 mg IV daily ) . Results A total of 
    Output:
    
Posaconazole had the highest probability of being the most effective agent in reducing IFI risk and all-cause mortality .
CONCLUSIONS IFI prophylaxis has a positive effect on IFI risk reduction .
However , its effect on all-cause mortality is not as pronounced .
The analysis has additionally pinpointed posaconazole as potentially the most effective IFI prophylaxis in neutropenic patients