Frequency and causes of antifungal treatment changes in allogeneic haematopoïetic cell transplant recipients with invasive mould infections

Roth, Romain Samuel; Masouridi‐Levrat, Stavroula; Giannotti, Federica; Mamez, Anne‐Claire; Glambedakis, Emmanouil; Lamoth, Frédéric; Bochud, Pierre-Yves; Erard, Véronique; Emonet, Stéphane; Delden, Christian van; Kaiser, Laurent; Chalandon, Yves; Neofytos, Dionysios

doi:10.1111/myc.13416

Cited by 5 publications

(13 citation statements)

References 40 publications

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“…We have previously reported long treatment durations of antifungal treatment, at a median of 200 and 293 days for IA and non‐IA IMI, respectively, in a single‐centre cohort study of allogeneic haematopoietic cell transplant (HCT) recipients 10,11 . Our findings suggest that in clinical practice, antifungal treatment duration of IMI may be longer than currently recommended.…”

Section: Introductionmentioning

confidence: 70%

“…We have previously reported long treatment durations of antifungal treatment, at a median of 200 and 293 days for IA and non-IA IMI, respectively, in a single-centre cohort study of allogeneic haematopoietic cell transplant (HCT) recipients. 10,11 Our findings suggest that in clinical practice, antifungal treatment duration of IMI may be longer than currently recommended. This may, in part, be attributed to the more complex cases observed, frequently not included in randomised clinical trials, but also based on institutional protocols and clinical experience.…”

Section: Backg Rou N Dmentioning

confidence: 85%

“…Nevertheless, our findings show that clinicians tend to adjust antifungal treatment duration based on the overall immune status of their patients, with patients with IMI often receiving treatment courses which last beyond the traditional 3 months of treatment as described in clinical trials. This is pertinent, considering the fact that patients are thus susceptible and prone to treatment‐associated adverse events and complications 10 …”

Section: Discussionmentioning

confidence: 99%

“…This was a retrospective observational single‐centre cohort study performed over a 10‐year period from 1 January 2010 through 1 January 2020. All adult (≥18‐year‐old) allogeneic HCT recipients who were treated for a proven or probable IMI during the study period were included, as previously described 10,11 . The study was approved by the institutional Ethics Committee (2020–01072).…”

Section: Methodsmentioning

confidence: 99%

“…Allogeneic HCT recipients were identified through the institutional HCT database and pertinent HCT and IMI data were collected, as previously described. 10,11 The following data were also collected at…”

Section: Data Collectionmentioning

confidence: 99%

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When and how do we stop antifungal treatment for an invasive mould infection in allogeneic haematopoietic cell transplant recipients?

Roth

Masouridi‐Levrat

Giannotti

et al. 2022

Mycoses

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Background: Limited data exist to describe end-of-treatment (EOT) parameters of antifungal therapy for invasive mould infections (IMI).Methods: In a 10-year cohort of consecutive adult allogeneic haematopoietic cell transplant recipients with proven/probable IMI, we describe treatment duration and patient profile at EOT.Results: There were 61 patients with 66 proven/probable IMI identified: 47/66 (71%) invasive aspergillosis (IA), 11/66 (17%) mucormycosis, and 8/66 (12%) other-IMI.Excluding 5 (8%) patients lost to follow-up, treatment was prematurely discontinued due to death or palliative care in 29/56 (51.8%) patients. Antifungal treatment was completed in 27 (48.2%) patients, for a median duration of 280 days (IQR: 110, 809): 258 (IQR: 110, 1905) and 307.5 (99, 809) days in IA and non-IA IMI, respectively.Treatment was continued after 90 and 180 days in 43/56 (76.8%) and 30/56 (53.6%) patients, respectively. At EOT, most patients were not neutropenic (ANC: 2.12 G/L, IQR: 0.04, 5.3), with CD4+ counts at 99 cells/μl (IQR: 0, 759) and immunoglobulins at 5.6 g/L (IQR: 2.3, 10.6). Most patients (16/27, 59.3%) were not receiving steroids at EOT, while 14/27 (53.9%) were on another type of immunosuppression. Amongst 15 patients with imaging at EOT, 12 (80%) had complete/partial radiologic response. Any chart documentation or an infectious disease consultation on treatment discontinuation was observed in 12/56 (21%) and 11/56 (20%) patients, respectively.Conclusions: Long treatment courses are observed in patients with IMI, due to prolonged immunosuppression. Although immune reconstitution and radiological response were frequently observed at EOT, consistent documentation of treatment discontinuation based on well-defined parameters is lacking.

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Section: Introductionmentioning

confidence: 70%

Section: Backg Rou N Dmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

See 3 more Smart Citations

When and how do we stop antifungal treatment for an invasive mould infection in allogeneic haematopoietic cell transplant recipients?

Roth

Masouridi‐Levrat

Giannotti

et al. 2022

Mycoses

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Effectiveness, Safety, and Patterns of Real-World Isavuconazole Use in Europe (2015–2019)

Neofytos,

Pagliuca,

Houghton

et al. 2024

Infect Dis Ther

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Antifungal Treatment Duration in Hematology Patients With Invasive Mold Infections: A Real-life Update

Portillo,

Ragozzino,

Stavropoulou

et al. 2024

Open Forum Infectious Diseases

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Background Limited data exist on when and how to stop antifungal treatment (AFT) in immunocompromised patients with invasive mold infections (IMI). Methods This is a retrospective multi-center study on adult patients with acute myelogenous leukemia (AML) and proven/probable IMI (01.01.2010-31.12.2022) in three University Hospitals. The primary objective was to describe AFT duration and adaptation. Secondary objectives were to investigate the reasons for AFT adjustments and prolongation. Results Seventy-one patients with 73 IMI were identified; 51 (71.8%) had an allogeneic hematopoietic cell transplant (HCT). Most infections were invasive aspergillosis (IA, 49/71, 69%), followed by mucormycosis (12, 16.9%), and other IMI (12, 16.9%); there were two mixed infections. Treatment duration was 227 days (IQR:115.5-348.5). There was no difference in AFT duration between patients with IA and non-IA IMI (P:0.85) or by center (P:0.92). Treatment was longer in patients with an allogeneic HCT versus not (P:0.004). Sixteen (22.5%) patients had no therapy modifications. In 55 (77.5%) patients 2 (median; IQR:1-3; range:1,8) changes were observed. There were 182 reasons leading to 165 changes, associated with clinical efficacy (82/182, 44.5%), toxicity (47, 25.8%), and logistical reasons (22, 12.1%); no reason was documented in 32 (18.8%) changes. AFT was continued beyond day-90/day-180 in 59 (83%)/39 (54.9%) patients, respectively, mostly due to persistence of immunosuppression. Conclusions AFT in AML patients with IMI is longer than recommended by guidelines and frequently associated with treatment adjustments due to variable reasons. More data and better guidance are required to optimize AFT duration and secondary prophylaxis administration according to immunosuppression.

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Frequency and causes of antifungal treatment changes in allogeneic haematopoïetic cell transplant recipients with invasive mould infections

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 5 publications

References 40 publications

When and how do we stop antifungal treatment for an invasive mould infection in allogeneic haematopoietic cell transplant recipients?

When and how do we stop antifungal treatment for an invasive mould infection in allogeneic haematopoietic cell transplant recipients?

Effectiveness, Safety, and Patterns of Real-World Isavuconazole Use in Europe (2015–2019)

Antifungal Treatment Duration in Hematology Patients With Invasive Mold Infections: A Real-life Update

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