Primary prophylaxis of invasive fungal infections in patients with haematologic malignancies. 2014 update of the recommendations of the Infectious Diseases Working Party of the German Society for Haematology and Oncology

Abstract

Invasive fungal infections cause substantial morbidity and mortality in immunocompromised patients, particularly in those with haematological malignancies and recipients of allogeneic haematopoietic stem cell transplantation. Difficulties in diagnosing invasive fungal infections and subsequent delays in treatment initiation lead to unfavourable outcomes and emphasise the importance of prophylaxis. Since the recommendations of the Infectious Diseases Working Party of the German Society for Haematology and Oncology in 2009, results of 14 additional clinical studies have been published comprising 2,899 patients and initiating this update. Key recommendations for adult patients are as follows: Posaconazole remains the drug of choice during remission-induction chemotherapy in acute myeloid leukaemia, myelodysplastic syndrome and allogeneic haematopoietic stem cell transplantation with graft versus host disease (AI). In the pre-engraftment period of allogeneic transplantation, several antifungals are appropriate and can be recommended with equal strength: voriconazole (BI), micafungin (BI), fluconazole (BI) and posaconazole (BII). There is poor evidence regarding antifungal prophylaxis in the post-engraftment period of allogeneic haematopoietic stem cell transplantation if no steroids for treatment of graft versus host disease are required. Aerosolised liposomal amphotericin B inhalation in conjunction with fluconazole can be used in patients with prolonged neutropenia (BII).

Clinical and Microbiological Characteristics of Breakthrough Candidemia in Allogeneic Hematopoietic Stem Cell Transplant Recipients in a Japanese Hospital

“…Almost all transplant recipients received antifungal agents at more than the minimum dose recommended for prophylaxis according to current treatment guidelines (11,12). The incidence of BC in our study was predicted to be higher than that among allo-HSCT recipients found in previous studies (14,15).…”

“…In the present study, all 17 recipients who developed BC during micafungin adminis- tration received 150 mg/day micafungin. In general, in current treatment guidelines, a lower dose of micafungin (50 mg/day) has been approved for use for prophylactic administration (11,12). This is probably why there are only a few studies on the development of BC when a sufficient dose of micafungin (Ն100 mg/day) is provided (9,17).…”

“…Clinicians could choose any of the antifungal agents, including itraconazole (oral solution), voriconazole, liposomal amphotericin B, or micafungin, for prophylaxis. Although 50 mg/day micafungin is recommended for use for prophylaxis in HSCT settings (11,12,32), 150 mg/day was used as an antimold prophylaxis for some patients in our allo-HSCT setting as part of a clinical trial that was approved by the IRB. Additionally, clinicians could change the antifungal agents empirically when they included fungal infections in the differential diagnosis.…”

“…Additionally, no study had been conducted with a cohort of patients receiving antifungal prophylaxis in which the patients who developed BC were directly compared to those who did not develop BC. Current treatment guidelines recommend antifungal prophylaxis for allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients (11)(12)(13). Therefore, we decided to conduct a study that focused on BC in a cohort of allo-HSCT recipients in order to clarify the characteristics and causes of BC.…”

Fungal and viral oral infections in individuals with onco-hematologic neoplasms in a University Hospital

“…Fungal and Viral Oral Infections in individuals with Onco-Hematologic Neoplasms in a University Hospital Fungal and Viral Oral Infections in individuals with Onco-Hematologic Neoplasms in a University Hospital the author affirmed that the patients were in an advanced stage of the disease, with inadequate nutritional and oral hygiene status, whereas in the present study, the patients were on nutritional support therapy, antifungal prophylaxis with a systemic antifungal agent 22 , received oral hygiene instructions and underwent dental follow-up during antineoplastic therapy, therefore presenting adequate oral hygiene.…”