European guidelines for antifungal management in leukemia and hematopoietic stem cell transplant recipients: summary of the ECIL 3—2009 Update

Abstract

In 2005, several groups, including the European Group for Blood and Marrow Transplantation, the European Organization for Treatment and Research of Cancer, the European Leukemia Net and the Immunocompromised Host Society created the European Conference on Infections in Leukemia (ECIL). The main goal of ECIL is to elaborate guidelines, or recommendations, for the management of infections in leukemia and stem cell transplant patients. The first sets of ECIL slides about the management of invasive fungal disease were made available on the web in 2006 and the papers were published in 2007. The third meeting of the group (ECIL 3) was held in September 2009 and the group updated its previous recommendations. The goal of this paper is to summarize the new proposals from ECIL 3, based on the results of studies published after the ECIL 2 meeting: (1) the prophylactic recommendations for hematopoietic stem cell transplant recipients were formulated differently, by splitting the neutropenic and the GVHD phases and taking into account recent data on voriconazole; (2) micafungin was introduced as an alternative drug for empirical antifungal therapy; (3) although several studies were published on preemptive antifungal approaches in neutropenic patients, the group decided not to propose any recommendation, as the only randomized study comparing an empirical versus a preemptive approach showed a significant excess of fungal disease in the preemptive group.

Efficacy and safety of micafungin for prophylaxis of invasive fungal infections in patients undergoing haplo-identical hematopoietic SCT

“…However, haplo-SCT has several limitations including higher graft failure rate, delayed immune reconstitution after transplantation with high rates of lifethreatening infections and severe acute and chronic GVHD. 20,21 A delayed hematologic and immunologic reconstitution is common after this therapeutic strategy, and impaired immune function after haplo-SCT with subsequent infections is a major cause of deaths in these patients. 22,23 Fluconazole has been routinely used in our center and several other institutions for many years and has become the standard treatment for the prophylaxis of IFI, because of its excellent antifungal effects in patients who have undergone Allo-SCT.…”

Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis

“…The control of infectious complications has improved since the development of molecular methods for viral and fungal detection, the use of preemptive treatments and prevention of nosocomial infections. [78][79][80][81] HSCT improvements Several changes in transplantation practice appeared to have contributed to improve outcomes. Better donor selection, as well as a more accurate HLA matching for unrelated donors, probably Figure 2.…”

Disseminated Geosmithia argillacea infection in a patient with gastrointestinal GvHD

“…Patients with GvHD are especially at risk for pulmonary fungal infections. 1 Prophylactic regimens for patients with GvHD include posaconazole 2 and voriconazole, 3 and have demonstrated ability to prevent invasive fungal infections in a majority of patients undergoing allo-SCT for haematological malignancies. However, zygomycetes, Fusarium spp., and other rare moulds may cause major problems due to their resistance to these commonly used antifungal agents.…”