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Management of invasive mycoses in hematology patients: current approaches

John R Perfect1

  • 1Division of Infectious Disease, Duke University Medical Center, Durham, North Carolina 27710, USA.

Oncology (Williston Park, N.Y.)
|January 18, 2005
PubMed

Insights

Hematopoietic stem cell transplant patients face common fungal infections like candidiasis and aspergillosis. Treatment strategies involve antifungal prophylaxis, empiric, and preemptive therapies, with various drug classes available.

Area of Science:

  • Medical Mycology
  • Hematology
  • Infectious Diseases

Background:

  • Hematopoietic stem cell transplant (HSCT) recipients and hematology/oncology patients are highly susceptible to invasive fungal infections.
  • Candidiasis and aspergillosis are the most prevalent and life-threatening fungal pathogens in this immunocompromised population.

Purpose of the Study:

  • To review current antifungal strategies for managing invasive fungal infections in HSCT and hematology/oncology patients.
  • To outline appropriate therapeutic choices based on pathogen, resistance patterns, and patient factors.

Main Methods:

  • Literature review of antifungal agents and treatment guidelines.
  • Analysis of drug classes including amphotericin B, triazoles, and echinocandins.
  • Consideration of prophylaxis, empiric, and preemptive treatment approaches.

Main Results:

  • Fluconazole is suitable for invasive candidiasis if no prior triazole exposure and low institutional resistance.
  • Echinocandins (e.g., caspofungin) are options when triazole resistance is a concern.
  • Voriconazole is often the first-line treatment for invasive aspergillosis.

Conclusions:

  • Tailored antifungal selection is crucial for optimizing outcomes in high-risk patients.
  • Lipid formulations of amphotericin B and echinocandins serve as effective alternatives for refractory or intolerant cases.

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