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J Antimicrob Chemother. 2018 Dec 1;73(12):3221-3230. doi: 10.1093/jac/dky286.

European guidelines for primary antifungal prophylaxis in adult haematology patients: summary of the updated recommendations from the European Conference on Infections in Leukaemia.

Author information

1
Department of Haematology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium.
2
Department of Haematology, Azienda Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
3
Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands.
4
Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
5
Centre for Medical Microbiology, University College London, London, UK.
6
Departments of Haematology and Allogeneic Stem Cell Transplantation, Karolinska University Hospital and Division of Haematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
7
Department of Internal Medicine - Haematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic.
8
Quality Unit, Pôle PréBloc, Saint-Louis and Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France.
9
Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.
10
Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
11
Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany.
12
Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany.
13
Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
14
Department of Haematology, Radboud University Medical Centre, Nijmegen, The Netherlands.
15
Hopital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Department of Haematology, Créteil, France.
16
Université Paris-Est-Créteil, Créteil, France.

Abstract

The European Conference on Infections in Leukaemia (ECIL) updated its guidelines on antifungal prophylaxis for adults using the grading system of IDSA. The guidelines were extended to provide recommendations for other haematological diseases besides AML and recipients of an allogeneic haematopoietic stem cell transplantation (HSCT). Posaconazole remains the drug of choice when the incidence of invasive mould diseases exceeds 8%. For patients undergoing remission-induction chemotherapy for AML and myelodysplastic syndrome (MDS), fluconazole can still offer an alternative provided it forms part of an integrated care strategy that includes screening with biomarkers and imaging. Similarly, aerosolized liposomal amphotericin B combined with fluconazole can be considered for patients at high risk of invasive mould diseases but other formulations of the polyene are discouraged. Fluconazole is still recommended as primary prophylaxis for patients at low risk of invasive mould diseases during the pre-engraftment phase of allogeneic HSCT whereas only a moderate recommendation could be made for itraconazole, posaconazole and voriconazole for patients at high risk. Posaconazole is strongly recommended for preventing invasive mould disease post-engraftment but only when graft-versus-host disease (GvHD) was accompanied by other risk factors such as its severity, use of an alternative donor or when unresponsive to standard corticosteroid therapy. The need for primary prophylaxis for other patient groups was less clear and should be defined by the estimated risk of invasive fungal disease (IFD).

PMID:
30085172
DOI:
10.1093/jac/dky286

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