title: A hematology consensus agreement on antifungal strategies for neutropenic patients with hematological malignancies and stem cell transplant recipients. Gruppo Italiano Malattie Ematologiche dell'Adulto, Gruppo Italiano Trapianto di Midollo Osseo, Associazione Italiana Ematologia ed Oncologia Pediatrica, Invasive Fungal Infections Cooperative Group of the European Organization for Research and Treatment of Cancer and Sorveglianza Epidemiologica delle Infezioni Fungine nelle Emopatie Maligne.
abstract: In the attempt to establish key therapy definitions and provide shared approaches to invasive fungal diseases in neutropenic patients, trials of empiric, preeemptive and targeted antifungal therapy (EAT, PAT and TAT) were reviewed, and a Consensus Development Conference Project was convened. The Expert-Panel concurred that all antifungal treatments, including EAT, should always follow an adequate diagnostic strategy and that the standard definition of PAT may be misleading: being PAT guided by the results of a diagnostic work-up, it should better be termed diagnostic-driven antifungal therapy (DDAT). The Expert-Panel agreed that radiological findings alone are insufficient for the choice of a TAT and that the identification of the etiologic pathogen is needed. The Consensus Agreement proceeded identifying which clinical and microbiological findings were sufficient to start a DDAT and which were not. Finally, an algorithm to rationalize the choice of antifungal drugs on the basis of clinical manifestations, antifungal prophylaxis, instrumental and laboratory findings was drawn up.
authors.affiliation: Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I, Rome, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Girmenia
authors.forename: Franco
authors.initials: F
authors.lastname: Aversa
authors.forename: Alessandro
authors.initials: A
authors.lastname: Busca
authors.forename: Anna
authors.initials: A
authors.lastname: Candoni
authors.forename: Simone
authors.initials: S
authors.lastname: Cesaro
authors.forename: Mario
authors.initials: M
authors.lastname: Luppi
authors.forename: Livio
authors.initials: L
authors.lastname: Pagano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rossi
authors.forename: Adriano
authors.initials: A
authors.lastname: Venditti
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Nosari
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D015415:Biomarkers; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000150:complications / Q000188:drug therapy; D002986:Clinical Trials as Topic; D004334:Drug Administration Schedule; D025141:Drug Resistance, Fungal; D004359:Drug Therapy, Combination; D064147:Febrile Neutropenia / Q000150:complications / Q000188:drug therapy*; D005658:Fungi / Q000187:drug effects / Q000302:isolation & purification; D019337:Hematologic Neoplasms / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D016867:Immunocompromised Host; D015337:Multicenter Studies as Topic; D009181:Mycoses / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D011292:Premedication; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D019172:Transplantation Conditioning / Q000009:adverse effects; D014230:Triazoles / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D015415:Biomarkers; D014230:Triazoles; D000666:Amphotericin B