Current approaches in antifungal prophylaxis in high risk hematologic malignancy and hematopoietic stem cell transplant patients.
Invasive fungal infections (IFIs) pose the most serious infectious risk to patients with hematologic malignancies and in those undergoing hematopoietic stem cell transplantation (HSCT). Invasive candidiasis has an incidence of 8-18% and a mortality of 30-40% in various reports. Invasive aspergillosis has an incidence of 4-15% and an even higher mortality of 60-85% cited in the published literature. IFIs have remained difficult to diagnose in a timely way in neutropenic and immunocompromised patients. A timely diagnosis is essential in promptly initiating antifungal therapy in order to optimize clinical outcomes. Thus, antifungal prophylaxis has an enormous appeal to minimize the threat from IFIs. In this article, the epidemiology and risk factors for IFIs as well as evidence from antifungal prophylaxis clinical trials in certain patient groups with hematologic malignancies are reviewed. Antifungal prophylaxis has been shown to be effective in certain settings. However, concerns about shifts in fungal epidemiology, emergence of resistance, drug toxicities, and drug interactions must be considered in deciding how and in whom to use antifungal prophylaxis.
Wirk
Baldeep
B
Division of Hematology and Oncology, College of Medicine, Bone Marrow Transplant Program, University of Florida, 1600 SW Archer Road, PO Box 100277, Gainesville, FL 32610, USA. baldeep.wirk@medicine.ufl.edu
Wingard
John R
JR
D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D002177:Candidiasis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D019337:Hematologic Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D003904:Mitosporic Fungi / Q000187:drug effects; D011292:Premedication; D012307:Risk Factors
D000935:Antifungal Agents