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Antifungal prophylaxis in bone marrow transplantation

S T Milliken1, R L Powles

  • 1Leukaemia Unit, Royal Marsden Hospital, Sutton, Surrey, United Kingdom.

Reviews of Infectious Diseases
|March 1, 1990
PubMed

Insights

Deep fungal infections pose a significant risk for bone marrow transplant recipients, especially during prolonged neutropenia. Current prophylactic antifungals are disappointing, necessitating novel strategies for prevention.

Area of Science:

  • Medical Mycology
  • Hematology
  • Transplant Medicine

Background:

  • Deep fungal infections are a major cause of mortality in bone marrow transplant (BMT) recipients.
  • Prolonged neutropenia is the primary risk factor for invasive fungal disease in this population.
  • Candida and Aspergillus species are the most frequent pathogens encountered.

Purpose of the Study:

  • To review the efficacy of current antifungal prophylaxis strategies in BMT recipients.
  • To discuss emerging antifungal agents and novel measures for preventing fungal infections in BMT patients.

Main Methods:

  • Review of existing literature on antifungal prophylaxis in bone marrow transplantation.
  • Analysis of the limitations of current prophylactic agents like oral polyenes (nystatin, amphotericin B) and ketoconazole.
  • Discussion of the potential of new antifungal agents and preventive strategies.

Main Results:

  • Oral polyene prophylaxis has yielded disappointing results in preventing deep fungal infections.
  • Systemic amphotericin B, while effective for treatment, is too toxic for prophylaxis.
  • Ketoconazole has limitations due to contraindications with cyclosporine and adverse reactions at effective doses.

Conclusions:

  • Existing antifungal prophylaxis regimens for BMT recipients are inadequate.
  • There is a critical need for improved and safer antifungal strategies to prevent invasive fungal infections.
  • Further research into novel antifungal agents and preventive measures is essential for improving outcomes in BMT patients.

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