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Primary antifungal prophylaxis in hematopoietic stem cell transplant recipients: clinical implications of recent

Kieren A Marr1

  • 1Division of Infectious Diseases, Oregon Health and Science University, Portland, Oregon 97239, USA. marrki@ohsu.edu

Current Opinion in Infectious Diseases
|July 3, 2008
PubMed
Abstract

Insights

New mold-active azole antifungal drugs show promise in preventing invasive fungal infections in hematopoietic stem cell transplant patients. Further research is needed for aerosolized amphotericin B and diagnostic strategies.

Area of Science:

  • Hematology
  • Infectious Diseases
  • Pharmacology

Background:

  • Fungal infections pose a significant risk for poor outcomes in hematopoietic stem cell transplant (HSCT) recipients.
  • Prophylaxis strategies are evolving with the advent of new antifungal agents to combat yeast and mold infections.

Purpose of the Study:

  • To review current antifungal prophylaxis strategies for HSCT recipients.
  • To evaluate the efficacy and safety of new antifungal drugs in preventing fungal infections post-HSCT.

Main Methods:

  • Review of clinical trials evaluating mold-active azoles (posaconazole, voriconazole).
  • Assessment of studies on aerosolized lipid formulations of amphotericin B.
  • Analysis of data on breakthrough infections and drug resistance.

Main Results:

  • Mold-active azoles effectively prevent invasive aspergillosis in hematologic malignancy patients and after allogeneic HSCT.
  • Challenges include optimal dosing, drug interactions, and managing resistant breakthrough infections.
  • Aerosolized amphotericin B shows potential for lung-directed delivery, but long-term safety data is pending.

Conclusions:

  • Mold-active azoles are recommended over fluconazole for prophylaxis in high-risk allogeneic HSCT recipients.
  • Additional research is required for diagnostic tests and aerosolized antifungal delivery methods.

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