Breakthrough Zygomycosis after Voriconazole Treatment in Recipients of Hematopoietic Stem-Cell Transplants

To the Editor: The Food and Drug Administration (FDA) approved voriconazole for the treatment of invasive aspergillosis partly on the basis of data published in a report in the Journal, 1 which showed an improved clinical response and improved survival with voriconazole treatment as compared with a strategy of initial treatment with amphotericin B deoxycholate. In patients with neutropenia and persistent fever, the use of voriconazole as empirical therapy failed to fulfill criteria for noninferiority as compared with liposomal amphotericin B, 2 and the results of that trial generated substantial discussion after the FDA declined approval of the drug for that indication. . . .