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Choices aplenty: antifungal prophylaxis in hematopoietic stem cell transplant recipients

Bone Marrow Transplantation volume 34, pages 377–389 (2004)Cite this article

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 pre-emptive therapy, thereby potentially decreasing cost and toxicity in high-risk patients.

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Acknowledgements

We gratefully acknowledge Dr John Wingard for his critical review of this article.

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Authors and Affiliations

  1. Department of Medicine, University Hospitals of Cleveland, Cleveland, OH, USA

    N S Hamza

  2. Department of Dermatology, University Hospitals of Cleveland, Cleveland, OH, USA

    M A Ghannoum

  3. Center For Medical Mycology and Ireland Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA

    H M Lazarus

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Correspondence to H M Lazarus.

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Hamza, N., Ghannoum, M. & Lazarus, H. Choices aplenty: antifungal prophylaxis in hematopoietic stem cell transplant recipients. Bone Marrow Transplant 34, 377–389 (2004). https://doi.org/10.1038/sj.bmt.1704603

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