An update on pharmacotherapy for fungal infections in allogeneic stem cell transplant recipients

Area of Science:

• Hematology
• Infectious Diseases
• Mycology

Background:

• Invasive fungal diseases (IFD) are a significant cause of morbidity and mortality in hematopoietic stem cell transplantation (HSCT) recipients.
• Effective management of IFD requires understanding local epidemiology, risk factors, and current treatment guidelines.

Purpose of the Study:

• To provide a comprehensive overview of the epidemiology, causes, and risk factors of IFD in allogeneic HSCT.
• To discuss current prophylaxis and treatment strategies for IFD across different phases of HSCT.
• To present recent data on antifungal agents, including formulations, dosing, safety, efficacy, and therapeutic drug monitoring, along with updated recommendations.

Main Methods:

• A literature search was conducted in PubMed, Scopus, and clinicaltrials.gov.
• The search focused on studies published between January 2014 and April 2024.
• The review synthesizes information on IFD epidemiology, risk factors, prophylaxis, and treatment in HSCT recipients.

Main Results:

• Antifungal prophylaxis and therapy selection should be guided by local IFD epidemiology.
• Fluconazole is recommended for prophylaxis before engraftment against Candida spp.; mold-active agents are preferred post-engraftment.
• First-line treatments include echinocandins for candidiasis, mold-active azoles or liposomal amphotericin B (L-AmB) for aspergillosis, and L-AmB or isavuconazole for mucormycosis.

Conclusions:

• Optimizing diagnostic tools for prompt and accurate IFD detection is crucial to minimize antifungal exposure, drug interactions, and costs.
• Further research is needed to refine treatments for resistant or refractory fungal strains in HSCT patients.
• The choice between empirical (fever-driven) and diagnostic-driven treatment strategies for IFD remains an area for further investigation.