Antimicrobial prophylaxis in adults and children undergoing hematopoietic cell transplantation: 2021 Polish recommendations

Abstract

Infections are still one of the most common causes of death after hematopoietic cell transplantation (HCT). Antimicrobial prophylaxis plays a crucial role in decreasing non-relapse mortality after HCT.The objective of this guideline paper was the presentation of current recommendations of antimicrobial prophylaxis for children and adults after hematopoietic cell transplantation, prepared in cooperation with Polish scientific hematological societies. Recommendations were prepared by the working group and finally approved by all 23 Polish transplant centers for children and adults. Existing (European Conference on Infections in Leukemia (ECIL) and European Society of Blood and Marrow Transplantation (EBMT) guidelines, as well as the results of a survey performed among all Polish transplant centers, were the background material for the working group. Recommendations are presented in sections dedicated to antibacterial prophylaxis, antifungal prophylaxis, antiviral prophylaxis, as well as prophylaxis of toxoplasmosis and infections with Pneumocystis jiroveci. Recommendations on the principles of vaccination against COVID-19 are provided based on the state of knowledge in September 2021. A section on guidelines of environmental prophylaxis is also presented.

Emergencies in patients undergoing hematopoietic stem cell transplantation

“…According to data from the Center for International Blood and Marrow Transplant Research (CIBMTR), within 100 days post-transplant, infectious complications account for significant percentages of the cause of death, estimated at 21% of patients undergoing auto-HSCT and 16-28% of allo-HSCT recipients, depending on the donor source [8]. It is essential to identify the population at high risk for infections and introduce effective standard prophylaxis [9]. The risk of infection results from the interaction of many factors related to the patient, the type of transplant, and the exposure to microorganisms.…”

Transborder program of allogeneic hematopoietic cell transplantations from unrelated donors for Ukrainian children between 2015–2020 in Bydgoszcz

“…Standard infectious prophylaxis, including environmental prophylaxis, was used according to commonly accepted strategies [5]. Antibacterial prophylaxis included oral phenoxypenicillin, cefuroxime, amoxicillin or ciprofloxacin up to neutrophil recovery and afterwards until the cessation of immunosuppressive therapy.…”

“…All patients received prophylaxis of PTLD on day +5 with rituximab at a single dose of 200 mg/m 2 [8]. Weekly screening for CMV and EBV DNA-emia was done, and preemptive treatment was applied in cases of virus reactivation [5,9]. Prevention of infection with pneumocystis jiroveci included cotrimoxazole until the end of immunosuppressive treatment.…”

Therapeutic drug monitoring: a key point in optimal treatment of invasive fungal disease

“…In order to maintain the correct therapeutic range of azoles which is both efficient and safe for the patient, therapeutic drug monitoring (TDM) is recommended [1]. In alignment with this, Polish scientific societies have recently recommended the use of posaconazole and voriconazole in various clinical conditions and strategies, with the support of TDM [2][3][4][5].…”

“…Nevertheless, the current Polish guidelines [2,5] are in line with increasing safety and efficacy in the treatment of infectious complications, something particularly necessary due to the development of new targeted anticancer therapy [10]. Therapeutic drug monitoring for antifungal azoles is still an unmet medical need, although we have taken a significant step forward.…”