Choices aplenty: antifungal prophylaxis in hematopoietic stem cell transplant recipients

Abstract

Summary:The incidence of invasive fungal infection (IFIs) in hematopoietic stem cell transplantation (HSCT) recipients ranges from 10 to 25% with an overall case fatality rate of up to 70-90%. Candida and Aspergillus genera remain the two most common pathogens. Although fluconazole prophylaxis in this population has been moderately effective in reducing mortality due to invasive candidiasis, this agent does not have activity against invasive aspergillosis (IA) and other mould. Several new agents such as voriconazole and caspofungin have enhanced potency and broad-spectrum antifungal activity and show promising results against yeasts and filamentous fungi when given as therapy and as chemoprophylaxis. Further, new diagnostic tools to detect circulating fungal antigens in biological fluids and PCR-based methods to detect species or genus-specific DNA or RNA have been developed. Incorporating these techniques along with clinical criteria appear to improve the accuracy of preclinical diagnosis of IFIs. Such approaches may alter the current treatment strategy from prophylaxis to preemptive therapy, thereby potentially decreasing cost and toxicity in high-risk patients.

A Risk Profile for Invasive Aspergillosis in Liver Transplant Recipients

“…The data summarized by Hamza et al [33] indicate that the echinocandins, especially caspofungin, are promising therapeutic options for antifungal prophylaxis as a result of their excellent safety profile, extended halflife, efficacy against most Aspergillus species and their reduced drug interactions. Their major drawback, however, is that they are not available as oral formulations.…”

“…The new triazoles are attractive alternatives for antifungal prophylaxis as all triazoles have enhanced potency and a broad spectrum of activity, and they are available in oral formulation [33]; for example, posaconazole is an extended-spectrum triazole with clinical activity against a wide range of fungal pathogens, including Candida spp., Aspergillus spp., zygomycetes, and Fusarium spp. [34].…”

Caspofungin for the treatment of fungal infections: a systematic review of randomized controlled trials

“…This is mainly attributed to the gradual increase in the number of patients with various factors that predispose to fungal infections. Among these factors are co-morbidity, including human immunodeficiency virus (HIV), transplantation, cancer, lymphoma and other haematological immunosuppressive diseases, medical treatment including chemotherapy, steroids, total parenteral nutrition, and procedures including the placement of central venous catheters and surgical operations [1][2][3][4][5][6][7][8][9][10][11][12].…”

Modern management of respiratory failure due to pulmonary mycoses following allogeneic hematopoietic stem‐cell transplantation

“…However, this procedure may cause life-threatening complications especially in the early post-transplant phase. Pulmonary complications represent a major cause of death with a high morbidity and mortality despite recent improvements in supportive therapies [1,2]. Depending on risk factors, the incidence of invasive fungal infections (IFI) in allogeneic HSCT recipients ranges from 14% to 25% [3,4].…”