Related Experiment Videos
Antifungal prophylaxis in hematopoietic stem cell transplant recipients
1Program in Infectious Disease, Fred Hutchinson Cancer Research Center, University of Washington, Seattle 98109-1024, USA.
Abstract:
Efforts at preventing and treating fungal infection in hematopoietic stem cell transplant (HSCT) recipients must take into account the types of infections likely to be encountered during the different risk periods in hosts with different underlying risks. Given the emergence of molds as prevalent pathogens and the long duration of risk in allogeneic HSCT recipients, optimal antifungal prophylaxis would consist of treatment that can be given over a prolonged period and that would provide both anti-Candida and anti-Aspergillus activity. Optimal empiric therapy would consist of a broad-spectrum agent in the absence of more sensitive and specific methods for microbial diagnosis. Fluconazole (Diflucan) is currently the standard prophylactic agent for candidiasis, although mold-active agents and alternative strategies for polyene administration are being investigated. The gold standardfor empiric therapy is currently a polyene antifungal, yet an increased appreciation for amphotericin B-resistant yeasts and molds, and less toxic mold-active alternatives, might lead to the use of other compounds in the future. The recent development of multiple alternatives emphasizes our need to establish treatment algorithms that consider both the likely pathogens and potential toxicities.
Insights
Preventing and treating fungal infections in hematopoietic stem cell transplant (HSCT) recipients requires tailored antifungal strategies. Optimal prophylaxis and empiric therapy must address Candida and Aspergillus, considering host risks and emerging resistance patterns.
Area of Science:
- Hematology
- Infectious Diseases
- Mycology
Background:
- Hematopoietic stem cell transplant (HSCT) recipients face significant risks of fungal infections.
- Fungal infections, particularly from molds like Aspergillus, are a major concern, especially in allogeneic HSCT.
- Different risk periods and host factors necessitate individualized approaches to antifungal management.
Purpose of the Study:
- To review current strategies for preventing and treating fungal infections in HSCT recipients.
- To discuss the need for antifungal agents with broad-spectrum activity against Candida and Aspergillus.
- To highlight the importance of considering host risk and emerging resistance in treatment algorithms.
Main Methods:
- Literature review of antifungal prophylaxis and empiric therapy in HSCT.
- Analysis of pathogen prevalence, including molds and yeasts.
- Evaluation of current and emerging antifungal agents and treatment guidelines.
Main Results:
- Fluconazole is standard for candidiasis prophylaxis, but mold-active agents are under investigation.
- Polyene antifungals remain a gold standard for empiric therapy, but resistance and toxicity are concerns.
- The development of alternative antifungal compounds necessitates updated treatment algorithms.
Conclusions:
- Antifungal prophylaxis and empiric therapy must be risk-stratified and pathogen-aware in HSCT patients.
- Prolonged prophylaxis with broad-spectrum antifungal activity is crucial for allogeneic HSCT recipients.
- Future treatment algorithms should integrate pathogen profiles, host factors, and novel antifungal agents to optimize outcomes and minimize toxicity.