In a nutshell
This report aimed to update recommendations from 2014 about primary prevention of invasive fungal infections in patients with hematological malignancies (blood cancers). There were several updates to the recommendations.
Some background
Acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) are hematological malignancies (HM). An HM is a cancer that begins in the cells of blood forming tissues. AML/ALL patients undergoing chemotherapy or allogeneic hematopoietic stem cell therapy (HSCT) are immunocompromised. These patients have an impaired immune system that struggles to fight infections. Immunocompromised patients are at risk of invasive fungal infections (IFI). IFI can cause death.
In 2014 the Infectious Diseases Working Party of the German Society for Hematology and Medical Oncology set out recommendations for primary prevention (prophylaxis) of IFI infections in patients with HM. Since 2014, 7 clinical trials about antifungal prevention in patients with HM have been completed. As a result, updates to the 2014 recommendations are required.
Methods & findings
This report used information from seven clinical trials involving 1227 patients. These patients had HM and received antifungal prophylaxis. The information was used to update the recommendations.
Posaconazole (Noxafil) delayed response tablets should be used for prophylaxis in patients undergoing chemotherapy for AML. Intravenous (IV) posaconazole can be used when the oral route is not suitable. General therapeutic drug monitoring (TDM) measures the concentration of drug in blood. TDM during posaconazole prophylaxis is not recommended but could be helpful in clinical failure cases.
IV liposomal amphotericin B didn’t decrease IFI rates for ALL patients. It is not recommended for prophylaxis. This patient group have significant risk of IFI.
Patients treated with voriconazole (Vfend) should undergo TDM within 2 to 5 days, and should be repeated as needed.
The bottom line
This report reviewed updates to the 2014 recommendations.
What’s next?
Consult your physician about IFI and suitable prophylaxis options.
Published By :
Annals of Hematology
Date :
Dec 07, 2017
