Risk factors and prophylaxis against invasive fungal disease for haematology and stem cell transplant recipients: an evolving field

Expert Rev Anti Infect Ther. 2016 Dec;14(12):1165-1177. doi: 10.1080/14787210.2016.1245613. Epub 2016 Oct 22.

Abstract

Due to increasing intensity and complexity of therapies and longer survivorship, many patients with haematologic malignancy (HM) are at risk of invasive fungal disease (IFD). Mortality from IFD is high and treatment of an episode of IFD results in an excess length of hospital stay and costs and delays delivery of curative therapy of the underlying haematologic condition. Therefore, prevention and early recognition and treatment of IFD are crucial. Areas covered: Risk factors particular to certain HMs and haematopoietic stem cell transplantation, as well as those risk factors universal to all HM groups are examined. Expert commentary: Risk stratification identifies those patients who would benefit most from mould active versus yeast active prophylaxis and those who can be safely managed with monitoring and clinically driven interventions for IFD. This approach aids in antifungal stewardship.

Keywords: Antifungal prophylaxis; haematologic malignancy; moulds; risk factors; stem cell transplantation.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / adverse effects
  • Age Factors
  • Antifungal Agents / administration & dosage
  • Antifungal Agents / adverse effects
  • Antifungal Agents / therapeutic use
  • Antineoplastic Agents / adverse effects
  • Environmental Pollution / adverse effects
  • Hematologic Neoplasms / complications*
  • Hematologic Neoplasms / microbiology
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Immunocompromised Host / drug effects
  • Invasive Fungal Infections / immunology
  • Invasive Fungal Infections / microbiology
  • Invasive Fungal Infections / mortality
  • Invasive Fungal Infections / prevention & control*
  • Neutropenia / drug therapy
  • Neutropenia / etiology
  • Opportunistic Infections / immunology
  • Opportunistic Infections / microbiology
  • Opportunistic Infections / mortality
  • Opportunistic Infections / prevention & control*
  • Risk Factors

Substances

  • Adrenal Cortex Hormones
  • Antifungal Agents
  • Antineoplastic Agents