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Secondary antifungal prophylaxis in hematological malignancy patients with previous invasive fungal disease: a

Mingjuan Liu1, Yan Li2, Yongqing Zhang3

  • 1Department of Hematology and BMT center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Hematology, the 309th Hospital of Chinese People's Liberation Army, 17 Heishanhu Road, Beijing 100091, China.

Plos One
|December 23, 2014
PubMed
Abstract

Insights

Secondary antifungal prophylaxis (SAP) is crucial for preventing invasive fungal disease (IFD) recurrence in patients with hematological malignancy. Allogeneic hematopoietic stem cell transplantation (HSCT) significantly increases IFD recurrence risk, necessitating tailored SAP strategies.

Area of Science:

  • Hematology
  • Infectious Diseases
  • Oncology

Background:

  • Invasive fungal disease (IFD) poses a significant threat, causing morbidity and mortality in patients undergoing chemotherapy or hematopoietic stem cell transplantation (HSCT) for hematological malignancies.
  • Recurrence of IFD post-treatment is linked to poorer patient outcomes, highlighting the need for effective preventive strategies.
  • Secondary antifungal prophylaxis (SAP) is a key consideration for managing IFD in this vulnerable patient population.

Purpose of the Study:

  • To evaluate the efficacy of various secondary antifungal prophylaxis (SAP) strategies in preventing invasive fungal disease (IFD) recurrence.
  • To identify the most appropriate SAP regimen for patients with hematological malignancy.
  • To determine risk factors associated with SAP failure in the context of IFD.

Main Methods:

  • Retrospective review of clinical data from 164 patients with prior IFD who underwent chemotherapy or HSCT between January 2008 and June 2013.
  • Follow-up of patients for 180 days post-chemotherapy or HSCT to assess IFD recurrence.
  • Analysis of clinical characteristics, diagnosis, SAP efficacy, and risk factors for SAP failure based on established IFD criteria.

Main Results:

  • Patients receiving SAP (73.78%) had a significantly lower IFD recurrence rate (16.5%) compared to those not receiving SAP (46.5%).
  • No significant difference in recurrence rates was observed between patients receiving SAP agents proven effective for their previous IFD versus those receiving other broad-spectrum antifungals (13.8% vs 19.0%).
  • Allogeneic HSCT was identified as an independent risk factor for IFD recurrence after SAP (25% recurrence vs 8.2% in chemotherapy or autologous HSCT patients).

Conclusions:

  • Secondary antifungal prophylaxis (SAP) is essential for preventing invasive fungal disease (IFD) recurrence in patients with hematological malignancy.
  • The risk of IFD recurrence is particularly elevated in patients undergoing allogeneic HSCT, underscoring the importance of SAP in this subgroup.
  • Further research may be warranted to optimize SAP regimens for high-risk patient populations.

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