Antifungal prophylaxis in adult stem cell transplantation and haematological malignancy.

Abstract:

:Antifungal prophylaxis can be recommended in patients undergoing induction chemotherapy for acute myeloid leukemia and treatment for grade 2 or greater or chronic extensive graft versus host disease. The evidence for prophylaxis is less clear in other clinical settings although certain groups such as patients with prolonged neutropenia after stem cell transplants using bone marrow or cord blood sources and with impaired cell mediated immunity secondary to treatments such as Alemtuzumab are at high risk. The decision to use prophylaxis and which agent to use will be influenced by effectiveness, number needed to treat and the likelihood of toxicity and drug interactions. The availability of rapid diagnostic tests for fungal infection and institutional epidemiology will also influence the need for and choice of prophylaxis. Whilst prophylaxis can be beneficial, it may impede the ability to make a rapid diagnosis of fungal infection by reducing the yield of diagnostic tests and change the epidemiology of fungal infection. As non-culture based diagnostic tests are refined and become more available there may be a shift from prophylaxis to early diagnosis and treatment.

journal_name

Intern Med J

authors

Slavin MA,Heath CH,Thursky KA,Morrissey CO,Szer J,Ling LM,Milliken ST,Grigg AP

doi

10.1111/j.1445-5994.2008.01723.x

subject

Has Abstract

pub_date

2008-06-01 00:00:00

pages

468-76

issue

6b

eissn

1444-0903

issn

1445-5994

pii

IMJ1723

journal_volume

38

pub_type

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