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Published on: July 1, 2020
[Consensus opinion on antifungal prophylaxis in haematologic patients: Results of the PROMIC project]
L Vázquez López1, T Villaescusa de la Rosa, R de la Cámara
1Lourdes Vázquez López, Hospital de Salamanca. Salamanca, Spain. lvazlo@usal.es.
Objective:
Invasive fungal disease (IFD) is an important cause of morbidity and mortality in haematological patients. Antifungal prophylaxis (AFP) is indicated for a number of clinical scenarios in this group of patients. The aim of this study was to reach a consensus on IFD prophylaxis in haematological patients in order to optimize their management.
Methods:
A committee of experts in haematology and infectious diseases compiled a survey of 79 items with controversial aspects about antifungal prophylaxis in haematological patients. The survey was evaluated in two rounds by a panel of experts following a modified Delphi methodology.
Results:
Forty-four experts in haematology and infectious diseases answered the survey. After two evaluation rounds, consensus was reached in 67 of the 79 items (84.8%), specifically 48 items were consensually agreed on (60.7%) and 19 were disagreed on (24.0%). Consensus was reached on prophylaxis candidates profiles and questions related to indications, mechanisms of action, spectrum of activity, toxicity and interactions of antifungal were elucidated. The usefulness of micafungin in IFD prophylaxis was particularly analysed. The consensus reached was that micafungin is an antifungal to be considered in this context as its safety profile and lower interaction potential may be advantageous.
Conclusions:
A broad consensus was found in the management of IFD prophylaxis in the haematological patient. This consensus provides practical indications about its optimal management and can help determine the profile of patients eligible for this type of intervention.
Insights
This study achieved consensus on antifungal prophylaxis (AFP) for invasive fungal disease (IFD) in hematology patients. Experts agreed on patient profiles and indications, optimizing management and treatment strategies.
Area of Science:
- Hematology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Invasive fungal disease (IFD) significantly contributes to morbidity and mortality in hematological patients.
- Antifungal prophylaxis (AFP) is a critical intervention for specific clinical scenarios in this vulnerable population.
Purpose of the Study:
- To establish a consensus among experts regarding the optimal management of IFD prophylaxis in hematological patients.
- To provide practical guidelines for the effective use of antifungal prophylaxis.
Main Methods:
- A modified Delphi methodology was employed, involving a survey distributed to a panel of hematology and infectious disease experts.
- Two rounds of evaluation were conducted to reach consensus on 79 controversial aspects of antifungal prophylaxis.
Main Results:
- Consensus was achieved on 67 out of 79 items (84.8%), with agreement on patient selection criteria and prophylaxis indications.
- Key aspects including mechanism of action, spectrum, toxicity, and drug interactions of antifungals were clarified.
- Micafungin was identified as a viable option for IFD prophylaxis due to its favorable safety profile and low interaction potential.
Conclusions:
- A significant consensus was reached on the management of IFD prophylaxis in hematological patients.
- The established consensus offers practical guidance for optimizing patient care and identifying appropriate candidates for antifungal prophylaxis.
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