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
Böhme
Angelika
A
Ruhnke
Markus
M
Buchheidt
Dieter
D
Cornely
Oliver A
OA
Einsele
Herrmann
H
Enzensberger
Ruxandra
R
Hebart
Holger
H
Heinz
Werner
W
Junghanss
Christian
C
Karthaus
Meinolf
M
Krüger
William
W
Krug
Utz
U
Kubin
Thomas
T
Penack
Olaf
O
Reichert
Dietmar
D
Reuter
Stefan
S
Silling
Gerda
G
Südhoff
Thomas
T
Ullmann
Andrew J
AJ
Maschmeyer
Georg
G
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