Advances in prophylaxis and treatment of invasive fungal infections: perspectives on hematologic diseases

Abstract

Invasive fungal infections (IFIs) are common causes of mortality and morbidity in patients with hematologic diseases. Delayed initiation of antifungal treatment is related to mortality. Aspergillus sp. is the leading cause of IFI followed by Candida sp. Diagnosis is often challenging owing to variable conditions related to underlying diseases. Clinical suspect and prompt management is important. Imaging, biopsy, and non-culture-based tests must be considered together. New diagnostic procedures have been improved, including antigen-based assays and molecular detection of fungal DNA. Among hematologic diseases, patients with acute myeloid leukemia, myelodysplastic syndrome, recipients of hematopoietic stem cell transplantation are at high risk for IFIs. Antifungal prophylaxis is recommended for these high-risk patients. There are continuous attempts to achieve ideal management of IFIs. Scoring system for quality control has been developed with important recommendations of current guidelines. Higher adherence to guidelines is related to decreased mortality in IFIs.

Dynamic changes in physical function during intensive chemotherapy affect transplant outcomes in older adults with AML

“…All patients received cyclosporin or tacrolimus with a short course of methotrexate (MTX) for graft-versus-host disease (GVHD) prophylaxis. Detailed transplantation protocols were described in supplemental materials and also in previously published manuscripts (21)(22)(23).…”

“…qRT-PCR was used for the RUNX1-RUNX1T1, CBFB-MYH11, or NPM1 MRD assessment (25). In the absence of the aforementioned molecular targets, we used Wilms tumor gene 1 (WT1) transcripts as MRD markers with a positivity cut-off value of >250 copies (23). The qRT-PCR levels represented the relative ratios of RUNX1-RUNX1T1, CBFB-MYH11, NPM1, or WT1 expression normalized to the expression of the reference gene ABL1 (1 × 10 4 ), as previously reported (25).…”

Successful Treatment of Rare Pulmonary Coprinopsis cinerea Infection in a 17-Year-Old Female After Hematopoietic Stem Cell Transplantation: A Case Report

“…Invasive fungal infections (IFIs) are among the most severe complications and contribute to high morbidity and mortality in hematopoietic stem cell transplantation (HSCT) recipients and patients with hematological malignancies. 1 Administration of high-dose chemotherapy, immunosuppressive agents, steroids, and broad-spectrum antibiotics increases the incidence of IFIs in HSCT recipients and patients with hematological disorders. 2 , 3 In addition, IFIs often exhibit rapid disease progression and a slow response to treatment, leading to limitations in diagnosing them and treatment delays.…”

“…3 Although antifungal prophylaxis is recommended in most cases of HSCT, the risk of developing an IFI remains high, particularly in patients with co-existing with other complications, such as prolonged neutropenia, severe viral and bacterial infections, and graft-versus-host diseases (GVHDs). 1,2 In addition, IFIs on antifungal prophylaxis in HSCT patients often have an insidious onset, which may increase the risk of misdiagnosis and delay treatment.…”

IFISTRATEGY: Spanish National Survey of Invasive Fungal Infection in Hemato-Oncologic Patients

“…In the face of persistent febrile neutropenia Comment: IA can have a dismal outcome in hematologic patients and delayed treatment is associated with a higher mortality rate [23]. It cannot be overstated that, classically, the most prevalent but unspecific sign of invasive pulmonary aspergillosis (IPA) is persistent fever despite treatment with broad-spectrum antibiotics [24], and that when persistent fever exists but the chest CT scan is considered normal, the clinician should consider other foci of IFI apart from the lungs [23].…”