A nationwide survey of deep fungal infections and fungal prophylaxis after hematopoietic stem cell transplantation in Japan

Abstract

Summary:We conducted a nationwide survey to define incidence of deep fungal infections and fungal prophylaxis practices after HSCT. In all, 63 institutions responded. Total number of in-patient transplantations was 935: 367 autologous, 414 allogeneic myeloablative, and 154 allogeneic reducedintensity (RIST) (n ¼ 154). Number of patients who were cared for in a clean room at transplant was 261 (71%) in autologous, 409 (99%) in conventional and 93 (66%) in RIST, respectively. All patients received prophylactic antifungal agents; 89% fluconazole. Number of patients who received the dosage recommended in the CDC guidelines (400 mg/day) was 135 (42%) in conventional transplant and 34 (30%) in RIST (P ¼ 0.037). Number of patients who received fluconazole until engraftment and beyond day 75 in conventional transplant vs RIST was, respectively, 324 (100%) vs 109 (97%), and 39 (12%) vs 18 (16%), with no significant difference between the two groups. A total of 37 patients (4.0%) were diagnosed with deep fungal infections; autologous transplantation (0.03%), conventional transplantation (6.0%) and RIST (7.1%). Wide variations in antifungal prophylaxis practice according to the type of transplant and the institutions, and deep fungal infection remain significant problems in RIST.

Reduced-intensity hematopoietic stem-cell transplantation for malignant lymphoma: a retrospective survey of 112 adult patients in Japan

“…The types of transplantation are autologous (40%), myeloablative allogeneic (45%), and reduced-intensity or nonmyeloablative allogeneic transplantation (15%). 8 Since 20% of RIST recipients had advanced malignant lymphoma, 8 approximately half of the patients with malignant lymphoma who underwent RIST in Japan were surveyed in this study.…”

Comparison between reduced intensity and conventional myeloablative allogeneic stem-cell transplantation in patients with hematologic malignancies aged between 50 and 59 years

“…The types of transplantations are autologous (40%), myeloablative allogeneic (45%), and reduced intensity or nonmyeloablative allogeneic transplantation (15%). 10 RIST recipients are generally treated as clinical studies in Japan. Most patients were incurable with conventional treatments and were considered inappropriate for conventional allo-SCT because they were age 450 years old and/or due to organ dysfunction (generally attributable to previous intensive chemo-and/or radiotherapy).…”

Medical cost analysis for antifungal prophylaxis in neutropenic patients with hematological malignancies: a systematic simulation analysis

“…The daily dosage of FLCZ applied in the analysis was 400 mg, but in Japan a daily dosage of between 100 and 200 mg is generally used for the purpose of prophylaxis [28]. The reason is that most of the source material for our analysis used 400 mg, which is the recommended dose in Europe and the United States [29]. Robenshtok et al described that prophylaxis with ITCZ reduced the documented IFI compared with FLCZ at a 400-mg dose [23].…”