Of yeasts and hyphae: a hematologist's approach to antifungal therapy.
Improvements in anticancer treatments, the ability to modify myelosuppression profiles, greater duration and intensity of immunosuppression, and the variety of available antimicrobial therapies have influenced the spectrum of pathogens associated with invasive fungal infection complicating treatment of hematological malignancies and hematopoietic stem cell transplantation. The approaches to the management of these infections encompass strategies of prevention for all those at risk, preemptive therapy based upon surrogates of infection before the onset of clinical disease, empirical therapy for patients with clinical evidence of early disease, and directed or targeted therapy for infected patients with established disease. Chemoprophylaxis is effective if applied to the highest risk patients over the duration of the risk. Preemptive strategies, while promising, have yet to be validated and linked to reliably predictive non-microbiological diagnostic techniques. Empirical antifungal therapy, as it is currently applied, now seems questionable. Patients with probable or proven invasive fungal infection still have suboptimal outcomes despite the availability of promising anti-fungal agents. Strategies examining the concept of dose-intensity and combination regimens require careful study and cannot yet be regarded as an acceptable standard of practice.
Bow
Eric J
EJ
Health Sciences Centre, 820 Sherbrook Street, Winnipeg, Manitoba, Canada. ebow@hsc.mb.ca
D000935:Antifungal Agents / Q000627:therapeutic use*; D019337:Hematologic Neoplasms / Q000150:complications* / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D009181:Mycoses / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D009894:Opportunistic Infections / Q000188:drug therapy / Q000517:prevention & control
D000935:Antifungal Agents