Modern management of respiratory failure due to pulmonary mycoses following allogeneic hematopoietic stem‐cell transplantation

Abstract

Pulmonary mycoses count among the most dangerous complications in allogeneic hematopoietic stem cell transplantation. Despite the establishment of antifungal chemoprophylaxis and empirical antifungal treatment, they frequently lead to respiratory failure and are still associated with an extraordinarily poor prognosis. However, the emergence of new antimycotics with alternative mechanisms of actions and decreased toxicity in combination with the development of new non culture-based diagnostic techniques may allow earlier, more aggressive and more effective antifungal treatment approaches. In addition, the optimized use of new technologies designed to augment spontaneous breathing efforts by patients, mechanical ventilation, as well as the advantages of early tracheostomy lead us to expect better outcomes in the treatment of respiratory failure due to pulmonary mycoses following allogeneic hematopoietic stem cell transplantation.

Invasive fungal infection in allogeneic hematopoietic stem cell transplant recipients: single center experiences of 12 years

“…Candida is the most common pathogen of early IFI, while mold is the most common pathogen of late IFI. In patients who also developed GVHD, IFI may occur at three to six months and even later (Koldehoff and Zakrzewski, 2005;Garcia-Vidal et al, 2008). Our data demonstrate that the median time for the development of ICI is earlier than that for IMI (140 d vs. 243 d, P<0.05), reflecting the fact that mold infections are more common in the late period after HSCT.…”

“…IFI is an important cause of post-transplant mortality. The incidence rate of IFI has been reported to be 10%-26% in HSCT recipients (Koldehoff and Zakrzewski, 2005;Post et al, 2007), with mortality ranging from 40% to 90% (Lin et al, 2001;Dagenais and Keller, 2009). …”

Safety and Efficacy of Infliximab Therapy in the Setting of Steroid-Refractory Acute Graft-versus-Host Disease

“…In our patient cohort, a total of 29 patients (83%) had infections and 12 patients (34%) died as a result of these infections. Among these, 6 patients (17%) developed IFI, with 4 dying secondary to the IFI [32][33][34]. Severe neutropenia observed in 12 patients (36%) after the initiation of infliximab therapy was thought to be an important factor contributing to their immunodeficiency state.…”

Increased susceptibility for aspergillosis and post‐transplant immune deficiency in patients with gene variants of TLR4 after stem cell transplantation

“…Aspergillus species, the most common mold causing invasive infections in immune‐suppressed persons, is particularly problematic in patients who have undergone HSCT. Attending to the complexity of the host and the characteristics of those fungi, the diagnosis and treatment of invasive fungal infection (IFI) remains problematic and raises considerable challenges . Although certain clinical risk factors for the development of IFI such as prolonged neutropenia have been identified, some patients at high risk remain unaffected for unclear reasons .…”