title: Is combination antifungal therapy for invasive aspergillosis a necessity in hematopoietic stem-cell transplant recipients?
abstract: OBJECTIVE
  The use of combination antifungal therapy in hematopoietic stem-cell transplantation patients is controversial and limited by a paucity of controlled data. The recent literature is reviewed and the relative arguments for and against combination antifungal therapy are outlined with summative recommendations to assist practitioners in decision-making.
  
  
  RESULTS
  There is an abundance of in-vitro and murine in-vivo combination antifungal literature, whereas clinical data are less abundant and controlled. Of the published case series there is a suggested benefit to combination therapy over monotherapy, although there are limitations to the available literature. Other issues in the combination debate that are addressed include the following: improved response rates and a survival advantage have been demonstrated in recent monotherapy studies; response rates in most published combination therapy studies do not suggest large gains over monotherapy; the lack of sustained survival advantage to combination therapy studies; and finally the consideration of host defenses in treatment responses.
  
  
  CONCLUSIONS
  Based on available data, combination therapy is not warranted at the initial diagnosis of invasive aspergillosis. Randomized, controlled trials with rigorous study design are needed.
authors.affiliation: Shands Healthcare at the University of Florida, 32610-0316, USA. leathhl@shands.ufl.edu
authors.forename: Helen L
authors.initials: HL
authors.lastname: Leather
authors.forename: John R
authors.initials: JR
authors.lastname: Wingard
mesh_terms: D000818:Animals; D000935:Antifungal Agents / Q000008:administration & dosage*; D001228:Aspergillosis / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D051379:Mice; D016032:Randomized Controlled Trials as Topic
chemical_list: D000935:Antifungal Agents