Risk stratification for invasive fungal infections in patients with hematological malignancies: SEIFEM recommendations.
Invasive fungal infections (IFIs) are an important cause of morbidity and mortality in immunocompromised patients. Patients with hematological malignancies undergoing conventional chemotherapy, autologous or allogeneic hematopoietic stem cell transplantation are considered at high risk, and Aspergillus spp. represents the most frequently isolated micro-organisms. In the last years, attention has also been focused on other rare molds (e.g., Zygomycetes, Fusarium spp.) responsible for devastating clinical manifestations. The extensive use of antifungal prophylaxis has reduced the infections from yeasts (e.g., candidemia) even though they are still associated with high mortality rates. This paper analyzes concurrent multiple predisposing factors that could favor the onset of fungal infections. Although neutropenia is common to almost all hematologic patients, other factors play a key role in specific patients, in particular in patients with AML or allogeneic HSCT recipients. Defining those patients at higher risk of IFIs may help to design the most appropriate diagnostic work-up and antifungal strategy.
Istituto di Ematologia, Università Cattolica S. Cuore, Roma, Italy. Electronic address: livio.pagano@unicatt.it.
Livio
L
Pagano
Stem Cell Transplant Center, AOU Citta' della Salute e della Scienza, Turin, Italy.
Alessandro
A
Busca
Clinica Ematologica, Azienda Ospedaliero-Universitaria Santa Maria Misericordia, Udine, Italy.
Anna
A
Candoni
Ematologia, Spedali Civili, Brescia, Italy.
Chiara
C
Cattaneo
Oncoematologia Pediatrica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Simone
S
Cesaro
Unità Funzionale di Ematologia, Azienda Ospedaliero-Universitaria Careggi e Università di Firenze, Italy.
Rosa
R
Fanci
Unità Operativa Complessa di Ematologia, Azienda Ospedaliera Universitaria Integrata di Verona, Italy.
Gianpaolo
G
Nadali
UOC Ematologia, Dipartimento di Scienze Mediche e Chirurgiche Materno Infantili e dell'Adulto, Università degli Studi di Modena e Reggio Emilia, Modena, Italy.
Leonardo
L
Potenza
Cattedra di Ematologia, Unità di Malattie del Sangue e Trapianto di Midollo Osseo, Dipartimento di Scienze Cliniche e Sperimentali, Università di Brescia e ASST Spedali Civili, Brescia, Italy.
Domenico
D
Russo
Istituto di Malattie Infettive, Università Cattolica S. Cuore, Roma, Italy.
Mario
M
Tumbarello
Divisione di Ematologia e Centro Trapianti Midollo, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
Annamaria
A
Nosari
Hematology and BMT Unit, Department of Clinical and Experimental Medicine, University of Parma, Italy.
Franco
F
Aversa
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D004198:Disease Susceptibility; D019337:Hematologic Neoplasms / Q000150:complications* / Q000473:pathology / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D015994:Incidence; D000072742:Invasive Fungal Infections / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D012306:Risk
Hematopoietic stem cell transplantation; Leukemia; Molds; Risk factors; Yeast