Treatment of invasive fungal infections in cancer patients--recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO).
Invasive fungal infections are a main cause of morbidity and mortality in cancer patients undergoing intensive chemotherapy regimens. Early antifungal treatment is mandatory to improve survival. Today, a number of effective and better-tolerated but more expensive antifungal agents compared to the former gold standard amphotericin B deoxycholate are available. Clinical decision-making must consider results from numerous studies and published guidelines, as well as licensing status and cost pressure. New developments in antifungal prophylaxis improving survival rates result in a continuous need for actualization. The treatment options for invasive Candida infections include fluconazole, voriconazole, and amphotericin B and its lipid formulations, as well as echinocandins. Voriconazole, amphotericin B, amphotericin B lipid formulations, caspofungin, itraconazole, and posaconazole are available for the treatment of invasive aspergillosis. Additional procedures, such as surgical interventions, immunoregulatory therapy, and granulocyte transfusions, have to be considered. The Infectious Diseases Working Party of the German Society of Hematology and Oncology here presents its 2008 recommendations discussing the dos and do-nots, as well as the problems and possible solutions, of evidence criteria selection.
ONKOLOGIKUM, Frankfurt am Museumsufer, Frankfurt, Germany. angelika.boehme@onkologikum.de
Angelika
A
Böhme
Markus
M
Ruhnke
Dieter
D
Buchheidt
Oliver A
OA
Cornely
Herrmann
H
Einsele
Ruxandra
R
Enzensberger
Holger
H
Hebart
Werner
W
Heinz
Christian
C
Junghanss
Meinolf
M
Karthaus
William
W
Krüger
Utz
U
Krug
Thomas
T
Kubin
Olaf
O
Penack
Dietmar
D
Reichert
Stefan
S
Reuter
Gerda
G
Silling
Thomas
T
Südhoff
Andrew J
AJ
Ullmann
Georg
G
Maschmeyer
D000818:Animals; D000935:Antifungal Agents / Q000627:therapeutic use*; D005858:Germany; D006405:Hematology; D006801:Humans; D009181:Mycoses / Q000150:complications* / Q000188:drug therapy*; D009369:Neoplasms / Q000150:complications* / Q000276:immunology / Q000628:therapy; D012955:Societies, Medical
D000935:Antifungal Agents