Prevention and therapy of fungal infections in cancer patients. A review of recently published information.
This review of recent publications in the field of fungal infections in cancer patients clearly confirms that protracted severe granulocytopenia is a major risk factor for their development. Because severe and prolonged granulocytopenia plays such a major predisposing role for fungal infections, it is likely that the use of the colony-stimulating factors, which are able to reduce the duration and the severity of granulocytopenia, might prove effective in decreasing the frequency and the severity of these infections. Another conclusion is that certain categories of patients with granulocytopenia might benefit from antifungal prophylaxis and empiric therapy. Conversely, there are other populations who will benefit only marginally from such strategies. Imidazoles, namely fluconazole, for the prevention of local and systemic Candida infections have been shown to be effective in granulocytopenic patients. So far, the development of resistance has not been a major problem. In patients at the greatest risk of developing severe fungal infections, such as those receiving high-dose corticosteroid therapy for GVHD after allogeneic bone marrow transplantation, early administration of low doses of amphotericin B seems to be effective in reducing the development of systemic fungal infection. In terms of therapy, amphotericin B is still the standard approach, especially for empiric treatment, prior to the recognition of a specific pathogen.
Klastersky
J
J
Service de Médicine, Clinique H.J. Tagnon, Institut Jules Bordet, Centre des Tumeurs de l'Université libre de Bruxelles, Brussels, Belgium.
D000380:Agranulocytosis / Q000150:complications; D000935:Antifungal Agents / Q000627:therapeutic use*; D003115:Colony-Stimulating Factors / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D006801:Humans; D016867:Immunocompromised Host; D009181:Mycoses / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D009369:Neoplasms / Q000150:complications*; D012307:Risk Factors
D000935:Antifungal Agents; D003115:Colony-Stimulating Factors