A nationwide survey of deep fungal infections and fungal prophylaxis after hematopoietic stem cell transplantation in Japan.
We conducted a nationwide survey to define incidence of deep fungal infections and fungal prophylaxis practices after HSCT. In all, 63 institutions responded. Total number of in-patient transplantations was 935: 367 autologous, 414 allogeneic myeloablative, and 154 allogeneic reduced-intensity (RIST) (n=154). Number of patients who were cared for in a clean room at transplant was 261 (71%) in autologous, 409 (99%) in conventional and 93 (66%) in RIST, respectively. All patients received prophylactic antifungal agents; 89% fluconazole. Number of patients who received the dosage recommended in the CDC guidelines (400 mg/day) was 135 (42%) in conventional transplant and 34 (30%) in RIST (P=0.037). Number of patients who received fluconazole until engraftment and beyond day 75 in conventional transplant vs RIST was, respectively, 324 (100%) vs 109 (97%), and 39 (12%) vs 18 (16%), with no significant difference between the two groups. A total of 37 patients (4.0%) were diagnosed with deep fungal infections; autologous transplantation (0.03%), conventional transplantation (6.0%) and RIST (7.1%). Wide variations in antifungal prophylaxis practice according to the type of transplant and the institutions, and deep fungal infection remain significant problems in RIST.
Imataki
O
O
Hematopoietic Stem Cell Transplant Unit, National Cancer Center Hospital, Tokyo, Japan.
Kami
M
M
Kim
S-W
SW
Gotoh
M
M
Komaba
S
S
Kasai
M
M
Hashino
S
S
Naito
K
K
Masuda
M
M
Anan
K
K
Teshima
H
H
Togitani
K
K
Inoue
T
T
Nishimura
M
M
Adachi
Y
Y
Fukuhara
T
T
Yamashita
T
T
Uike
N
N
Kobayashi
Y
Y
Hamaguchi
M
M
Higuchi
M
M
Kawakami
K
K
Takaue
Y
Y
D000935:Antifungal Agents / Q000627:therapeutic use; D003625:Data Collection; D015725:Fluconazole / Q000627:therapeutic use; D006402:Hematologic Diseases / Q000150:complications / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007564:Japan; D009181:Mycoses / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011292:Premedication / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000379:methods / Q000706:statistics & numerical data; D014182:Transplantation, Autologous / Q000706:statistics & numerical data; D014184:Transplantation, Homologous / Q000706:statistics & numerical data
D000935:Antifungal Agents; D015725:Fluconazole