Antifungal prophylaxis in bone marrow transplant

Area of Science:

• Mycology
• Hematology
• Infectious Diseases

Background:

• Disseminated fungal infections in bone marrow transplant (BMT) patients, particularly those caused by Candida tropicalis and Candida albicans, are associated with a significant mortality rate of 38.8%.
• Prophylactic use of fluconazole is suggested to prevent these life-threatening infections.
• Infections caused by Candida krusei and Torulopsis glabrata typically do not increase mortality and are manageable with appropriate antifungal therapy.

Purpose of the Study:

• To evaluate the benefits and risks of antifungal prophylaxis in patients undergoing BMT.
• To assess the efficacy of fluconazole and amphotericin B in preventing fungal infections post-BMT.
• To review the current literature on optimal antifungal prophylaxis strategies for BMT recipients.

Main Methods:

• Literature review of studies on antifungal prophylaxis in BMT patients.
• Analysis of data regarding mortality rates associated with different fungal species.
• Comparison of prophylactic efficacy between fluconazole and amphotericin B.

Main Results:

• Fluconazole prophylaxis appears to outweigh the risks of increased colonization by less pathogenic fungi (C. krusei, T. glabrata).
• Fluconazole can prevent disseminated fungal infections with high mortality rates.
• Low-dose amphotericin B shows some promise against aspergillosis but has conflicting evidence regarding overall Candida infection prevention.

Conclusions:

• Oral or intravenous fluconazole (200-400 mg/d) or intravenous amphotericin B (0.1-0.25 mg/kg/d) may be valuable for antifungal prophylaxis in BMT patients.
• Further research is needed to determine optimal dosing and identify patient subgroups who benefit most from prophylaxis.
• Clinicians must be aware of the potential for increased colonization by less pathogenic fungi with fluconazole use.