ECIL-6 guidelines for the treatment of invasive candidiasis, aspergillosis and mucormycosis in leukemia and hematopoietic stem cell transplant patients

Abstract

The European Conference on Infections in Leukemia (ECIL) provides recommendations for diagnostic strategies and prophylactic, pre-emptive or targeted therapy strategies for various types of infection in patients with hematologic malignancies or hematopoietic stem cell transplantation recipients. Meetings are held every two years since 2005 and evidence-based recommendations are elaborated after evaluation of the literature and discussion among specialists of nearly all European countries. In this manuscript, the ECIL group presents the 2015-update of the recommendations for the targeted treatment of invasive candidiasis, aspergillosis and mucormycosis. Current data now allow a very strong recommendation in favor of echinocandins for first-line therapy of candidemia irrespective of the underlying predisposing factors. Anidulafungin has been given the same grading as the other echinocandins for hemato-oncological patients. The beneficial role of catheter removal in candidemia is strengthened. Aspergillus guidelines now recommend the use of either voriconazole or isavuconazole for first-line treatment of invasive aspergillosis, while first-line combination antifungal therapy is not routinely recommended. As only few new data were published since the last ECIL guidelines, no major changes were made to mucormycosis recommendations.

MUCORMYCOSIS IN ONCOHEMATOLOGY PATIENTS (results of the prospective study)

“…Согласно современным международным рекомен-дациям, обязательными условиями успешного лече-ния мукормикоза у онкогематологических больных являются ранняя высокодозная противогрибковая терапия в сочетании с активным хирургическим уда-лением пораженных тканей, а также устранение или уменьшение выраженности факторов риска (конт-роль основного заболевания, коррекция нейтропении, отмена ГКС и пр.) [21].…”

“…Для стартовой терапии рекомендовано примене-ние липидных форм АмВ, из которых в нашей стране доступен только липидный комплекс АмВ, его ис-пользование возможно в комбинации с каспофунги-ном [21].…”

“…Позаконазол ре-комендовано применять после стабилизации состоя-ния пациента, а также при невозможности стартовой терапии липидным АмВ [21]. В связи с выраженной нефротоксичностью АмВ деоксихолат является альтернативным препаратом.…”

Antifungal Stewardship

“…Alternatif olarak vorikonazol, mikafungin veya kaspofungin kullanılabilir. Primer tedavide IDSA rehberinde vorikonazol (2 x 6 mg/kg yükleme, 2 x 4 mg/ kg idame) ilk seçenek olarak, alternatif tedavide L-AmB (3-5 mg/kg) veya isavukonazol (2 gün 3 x 200 mg, daha sonra 200 mg/gün) önerilirken, ECIL-6 rehberinde isavukonazol de ilk seçenek olarak önerilmektedir [40,46] .…”

Treatment of Chronic Pulmonary Aspergillosis: Current Standards and Future Perspectives

“…Given the high intra-and interpatient variability of voriconazole and itraconazole plasma concentrations, TDM has been strongly recommended by the European Conference on Infections in Leukemia-6 (ECIL-6) and the ESCMID/ECMM/ERS 2017 guidelines for both triazoles, to ensure efficacy and avoid toxicity (Table 2) [28,29]. For voriconazole, the first trough level should be obtained between days 2 and 5 and, given the high intrapatient variability, optimally repeated once per week, to ensure plasma concentrations remain within the small therapeutic window of > 1 mg/L and < 6 mg/L [30,31].…”