Foiling fungal disease post hematopoietic cell transplant: review of prophylactic strategies

Rubinstein, Sam; Culos, Kathryn A.; Savani, Bipin N.; Satyanarayana, Gowri

doi:10.1038/bmt.2017.222

Cited by 5 publications

(8 citation statements)

References 81 publications

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“…Patients with hematologic malignancies are at high risk of developing invasive fungal disease (IFD). The highest incidences have been reported in allogeneic hematopoietic cell transplant (HCT) recipients and in patients with acute myeloid leukemia (AML) receiving induction remission chemotherapy [1][2][3][4][5][6]. In addition, recent studies have shown a high incidence of IFD in patients with acute lymphoid leukemia (ALL) [7,8], and the emergence of a new group at risk: patients with chronic lymphoproliferative diseases receiving ibrutinib [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of Invasive Fungal Diseases in Patients with Hematologic Malignancies and Hematopoietic Cell Transplantation Recipients Managed with an Antifungal Diagnostic Driven Approach

Bergamasco

Pereira

Arrais‐Rodrigues

et al. 2021

JoF

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Patients with hematologic malignancies and hematopoietic cell transplant recipients (HCT) are at high risk for invasive fungal disease (IFD). The practice of antifungal prophylaxis with mold-active azoles has been challenged recently because of drug–drug interactions with novel targeted therapies. This is a retrospective, single-center cohort study of consecutive cases of proven or probable IFD, diagnosed between 2009 and 2019, in adult hematologic patients and HCT recipients managed with fluconazole prophylaxis and an antifungal diagnostic-driven approach for mold infection. During the study period, 94 cases of IFD occurred among 664 hematologic patients and 316 HCT recipients. The frequency among patients with allogeneic HCT, autologous HCT, acute leukemia and other hematologic malignancies was 8.9%, 1.6%, 17.3%, and 6.4%, respectively. Aspergillosis was the leading IFD (53.2%), followed by fusariosis (18.1%), candidiasis (10.6%), and cryptococcosis (8.5%). The overall 6-week mortality rate was 37.2%, and varied according to the host and the etiology of IFD, from 28% in aspergillosis to 52.9% in fusariosis. Although IFD occurred frequently in our cohort of patients managed with an antifungal diagnostic driven approach, mortality rates were comparable to other studies. In the face of challenges posed by the use of anti-mold prophylaxis, this strategy remains a reasonable alternative.

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Section: Introductionmentioning

confidence: 99%

Epidemiology of Invasive Fungal Diseases in Patients with Hematologic Malignancies and Hematopoietic Cell Transplantation Recipients Managed with an Antifungal Diagnostic Driven Approach

Bergamasco

Pereira

Arrais‐Rodrigues

et al. 2021

JoF

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“…During the pre-engraftment period, the risk for IMI is elevated due to profound neutropenia. 3 Combined with the possibility that high-risk patients with AML or MDS may not have received adequate anti-mold prophylaxis prior to allo-HSCT at our institution, it is not surprising that our results showed a high frequency of IMI during pre-engraftment.…”

Section: Discussionmentioning

confidence: 59%

“…4 While IMI carries a significant risk for mortality, the routine use of mold-active agents for prophylaxis remains a subject of debate. 3,6,20 In this study, patients received antifungal prophylaxis with micafungin followed by fluconazole, with the option to escalate to voriconazole in patients receiving corticosteroids for GVHD. The incidence rate of proven or probable IMI during the study period was 18.4 cases per 100 patient-years, with a one-year cumulative incidence of 14%.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…The pre-engraftment period is associated with profound neutropenia from intensive chemotherapy, while the post-engraftment phase frequently requires ongoing immunosuppression for prevention of graftversus-host disease (GVHD). 2,3 Infectious complications contribute significantly to the mortality of patients undergoing allo-HSCT, with infection accounting for over 20% of deaths post-transplant. 4 Invasive mold infections (IMI) can be especially devastating, with mortality after invasive aspergillosis, the most common type of IMI in allo-HSCT, of over 60%.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a primary antifungal prophylaxis protocol for preventing invasive mold infections after allogeneic hematopoietic stem cell transplantation

Herity

Cruz

Aziz

2021

J Oncol Pharm Pract

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Introduction Invasive mold infections contribute to morbidity and mortality in patients undergoing allogeneic hematopoietic stem cell transplantation. The optimal strategy for primary antifungal prophylaxis in this patient population remains uncertain. Methods Medical records of patients who underwent allogeneic hematopoietic stem cell transplantation between 1 January 2013 and 31 December 2017 were retrospectively reviewed. Adult patients were included if they received micafungin followed by fluconazole, with the option to escalate to voriconazole, for antifungal prophylaxis. The primary outcome was the incidence rate of proven or probable invasive mold infection. Secondary outcomes were time to invasive mold infection diagnosis, invasive mold infection-related mortality, and risk factors associated with invasive mold infection. Results Two hundred patients were included in the study, a majority of whom underwent matched unrelated (46%) or matched related (33%) donor transplants. The incidence rate of proven or probable invasive mold infection was 18.4 cases per 100 patient-years, with a one-year cumulative incidence of 14%. Median time to proven or probable invasive mold infection was 94 days post-transplant (IQR 26–178), with invasive mold infection-related mortality occurring in 18 (64%) of 28 patients diagnosed with invasive mold infection. Comparison of invasive mold infection-free survival by potential risk factors failed to show any significant differences. Conclusions In this real-life cohort of allogeneic hematopoietic stem cell transplantation recipients, the incidence of proven or probable invasive mold infection was higher than expected based on previous literature. In the absence of standard guidance on anti-mold prophylaxis in this patient population and given that unique risk factors for invasive mold infection may differ between institutions, it is essential that centers performing allogeneic hematopoietic stem cell transplantation routinely monitor their antifungal prophylaxis strategies for effectiveness.

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Long-term follow-up of patients with poor-risk acute leukemia treated on a phase 2 trial undergoing intensified conditioning regimen prior to allogeneic hematopoietic cell transplantation

Salhotra

Yang

Mokhtari

et al. 2021

Leukemia & Lymphoma

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Foiling fungal disease post hematopoietic cell transplant: review of prophylactic strategies

Cited by 5 publications

References 81 publications

Epidemiology of Invasive Fungal Diseases in Patients with Hematologic Malignancies and Hematopoietic Cell Transplantation Recipients Managed with an Antifungal Diagnostic Driven Approach

Epidemiology of Invasive Fungal Diseases in Patients with Hematologic Malignancies and Hematopoietic Cell Transplantation Recipients Managed with an Antifungal Diagnostic Driven Approach

Evaluation of a primary antifungal prophylaxis protocol for preventing invasive mold infections after allogeneic hematopoietic stem cell transplantation

Long-term follow-up of patients with poor-risk acute leukemia treated on a phase 2 trial undergoing intensified conditioning regimen prior to allogeneic hematopoietic cell transplantation

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