Antifungal therapy in hematopoietic stem cell transplant recipients

Abstract

Invasive fungal infections (IFI) represent a major hindrance to the success of hematopoietic stem cell transplantation (HSCT), contributing substantially to morbidity and infection-related mortality. During the most recent years several reports indicate an overall increase of IFI among hematologic patients, in particular, invasive aspergillosis, that may be explained, at least partially, by the fact that diagnoses only suspected in the past, are now more easily established due to the application of serum biomarkers and early use of CT scan. Along with new diagnostic options, comes the recent development of novel antifungal agents that expanded the spectrum of activity over traditional treatments contributing to the successful management of fungal diseases. When introduced in 1959, Amphotericin B deoxycholate (d-AmB) was a life-saving drug, and the clinical experience over 50 years has proven that this compound is effective although toxic. Given the superior safety profile, lipid formulations of AmB have now replaced d-AmB in many circumstances. Similarly, echinocandins have been investigated as initial therapy for IA in several clinical trials including HSCT recipients, although the results were moderately disappointing leading to a lower grade of recommendation in the majority of published guidelines. Azoles represent the backbone of therapy for treating immunocompromised patients with IFI, including voriconazole and the newcomer isavuconazole; in addition, large studies support the use of mold-active azoles, namely voriconazole and posaconazole, as antifungal prophylaxis in HSCT recipients.The aim of the present review is to summarize the clinical application of antifungal agents most commonly employed in the treatment of IFI.

Early and late complications following hematopoietic stem cell transplantation in pediatric patients – A retrospective analysis over 11 years

“…[ 8 ] Transplantation-associated morbidity and mortality rates have declined significantly in recent years due to advances in transplantation medicine with tailored conditioning regimens, precise HLA (human-leucocyte-antigen) -typing, improved supportive therapy, and prophylaxis against severe infections. [ 9 ] Further reduction of the complication rate to improve outcomes following HSCT requires detailed therapy and follow-up care protocols tailored to each patient’s risk factors. Our relatively heterogeneous patient collective reflects real pediatric oncological clinical practice in use of stem cell transplantation.…”

Impact of Antibiotics on the Proliferation and Differentiation of Human Adipose-Derived Mesenchymal Stem Cells

“…Antibiotics are extremely important in transplantation and regenerative medicine procedures. Isolation and cultivation of adipose-derived stem cells usually involves the presence of the penicillin-streptomycin mixture [ 2 , 5 , 8 , 9 ] although some studies have also suggested using amphotericin B because of its widespread antifungal activity [ 10 , 11 ]. Gentamycin is also commonly used in cell cultures, although a penicillin-streptomycin (PS) mixture is the only one that is recommended by the American Type Culture Collection (ATCC) [ 12 ].…”

“…Gentamycin is also commonly used in cell cultures, although a penicillin-streptomycin (PS) mixture is the only one that is recommended by the American Type Culture Collection (ATCC) [ 12 ]. Protective/preventive antibiotic therapy improves the success/safety of transplantation procedures [ 10 ]. To minimize complications, stem cells must be isolated and cultured under the optimal conditions for a particular cell type, in order to use them in transplantology.…”

Invasive fungal disease in patients undergoing umbilical cord blood transplantation after myeloablative conditioning regimen

“…This risk score may have important implications to tailor antifungal prophylaxis in our patients, especially in those with one or more RFs who may benefit from other prophylaxis (posaconazole or isavuconazole). 44 Importantly, we also identified a very low-risk subgroup of UCBT recipients in whom we can speculate that such a group may not require antimold prophylaxis at all. Despite appropriate antifungal therapy, we report 6-and 12-week mortality rates of 36% Among IYDs, we found that candidemia was the most common event characterized by its early presentation (50% occurred before engraftment) which is consistent with recent experiences.…”