Primary prophylaxis of invasive fungal infections in patients with hematologic malignancies. Recommendations of the Infectious Diseases Working Party of the German Society for Haematology and Oncology.
There is no widely accepted standard for antifungal prophylaxis in patients with hematologic malignancies. The Infectious Diseases Working Party of the German Society for Haematology and Oncology assigned a committee of hematologists and infectious disease specialists to develop recommendations. Literature data bases were systematically searched for clinical trials on antifungal prophylaxis. The studies identified were shared within the committee. Data were extracted by two of the authors (OAC and MSi). The consensus process was conducted by email communication. Finally, a review committee discussed the proposed recommendations. After consensus was established the recommendations were finalized. A total of 86 trials were identified including 16,922 patients. Only a few trials yielded significant differences in efficacy. Fluconazole 400 mg/d improved the incidence rates of invasive fungal infections and attributable mortality in allogeneic stem cell recipients. Posaconazole 600 mg/d reduced the incidence of IFI and attributable mortality in allogeneic stem cell recipients with severe graft versus host disease, and in patients with acute myelogenous leukemia or myelodysplastic syndrome additionally reduced overall mortality. Aerosolized liposomal amphotericin B reduced the incidence rate of invasive pulmonary aspergillosis. Posaconazole 600 mg/d is recommended in patients with acute myelogenous leukemia/myelodysplastic syndrome or undergoing allogeneic stem cell recipients with graft versus host disease for the prevention of invasive fungal infections and attributable mortality (Level A I). Fluconazole 400 mg/d is recommended in allogeneic stem cell recipients until development of graft versus host disease only (Level A I). Aerosolized liposomal amphotericin B is recommended during prolonged neutropenia (Level B II).
Cornely
Oliver A
OA
Klinikum der Universität zu Köln, Klinik I für Innere Medizin Zentrum für Klinische Studien (BMBF 01KN0706), Köln, Germany. oliver.cornely@ctuc.de
Böhme
Angelika
A
Buchheidt
Dieter
D
Einsele
Hermann
H
Heinz
Werner J
WJ
Karthaus
Meinolf
M
Krause
Stefan W
SW
Krüger
William
W
Maschmeyer
Georg
G
Penack
Olaf
O
Ritter
Jörg
J
Ruhnke
Markus
M
Sandherr
Michael
M
Sieniawski
Michal
M
Vehreschild
Jörg-Janne
JJ
Wolf
Hans-Heinrich
HH
Ullmann
Andrew J
AJ
D000935:Antifungal Agents / Q000627:therapeutic use; D005858:Germany / Q000453:epidemiology; D019337:Hematologic Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D006405:Hematology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008495:Medical Oncology; D009181:Mycoses / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D012955:Societies, Medical; D014184:Transplantation, Homologous
D000935:Antifungal Agents