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Fungal pneumonia in patients with hematologic malignancies: current approach and management
Victor E Mulanovich1, Dimitrios P Kontoyiannis
1Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA. vmulanov@mdanderson.org
Purpose Of Review:
Fungal pneumonia is the most frequent presentation of invasive mold infections (IMIs) in patients with hematologic malignancies. In this review, we summarize recent advances in the epidemiology, diagnosis, and treatment of fungal pneumonia and improvement in the outcome of such patients.
Recent Findings:
The epidemiology of IMIs in hematopoietic stem cell transplant recipients has evolved in response to changes in conditioning regimens, increasing use of alternative sources of stem cells and antifungal prophylaxis, among other factors. PCR analysis and serologic tests, used in combination with imaging findings, have improved the timing and accuracy of diagnosis of these infections.Recent guidelines incorporated evidence-based treatment recommendations; however, application in real world situations is often difficult. A new treatment approach known as preemptive therapy, based on screening with biomarkers combined with early clinical and imaging findings, is being compared with the traditional empirical therapy in neutropenic patients with persistent or recurrent fever. The use of new triazoles and prompt diagnosis has contributed to improved outcomes in these patients. In addition, therapeutic drug monitoring may be useful when administering voriconazole.
Summary:
Evidence-based diagnosis and treatment of fungal pneumonia in patients with hematologic malignancies are becoming increasingly institution-specific and patient-specific, integrating host factors, new diagnostic methods, and epidemiologic and pharmacologic considerations.
Insights
Recent advances in diagnosing and treating fungal pneumonia in hematologic malignancy patients improve outcomes. New diagnostic methods and tailored treatments are key for better patient-specific care.
Area of Science:
- Hematology
- Infectious Diseases
- Mycology
Background:
- Fungal pneumonia is a common invasive mold infection (IMI) in patients with hematologic malignancies.
- Epidemiology of IMIs in hematopoietic stem cell transplant recipients is evolving due to changes in treatments and prophylaxis.
Purpose of the Study:
- To review recent advances in the epidemiology, diagnosis, and treatment of fungal pneumonia in patients with hematologic malignancies.
- To discuss improvements in patient outcomes related to invasive mold infections.
Main Methods:
- Review of recent literature on fungal pneumonia in immunocompromised patients.
- Analysis of diagnostic advancements including PCR, serologic tests, and imaging.
- Evaluation of treatment strategies, including preemptive and empirical therapies, and new antifungal agents.
Main Results:
- Improved diagnostic accuracy and timeliness through combined use of PCR, serologic tests, and imaging.
- Newer triazoles and prompt diagnosis contribute to better patient outcomes.
- Preemptive therapy is being compared to traditional empirical therapy for febrile neutropenic patients.
Conclusions:
- Diagnosis and treatment of fungal pneumonia are becoming increasingly personalized.
- Integration of host factors, novel diagnostics, and pharmacologic considerations is crucial.
- Institution-specific and patient-specific approaches enhance care for hematologic malignancy patients.
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