European guidelines for primary antifungal prophylaxis in adult haematology patients: summary of the updated
Title | European guidelines for primary antifungal prophylaxis in adult haematology patients: summary of the updated |
Publication Type | Journal Article |
Year of Publication | 2018 |
Authors | Maertens, J. A., Girmenia C., Brüggemann R. J., Duarte R. F., Kibbler C. C., Ljungman P., Racil Z., Ribaud P., Slavin M. A., Cornely O. A., J Donnelly P., & Cordonnier C. |
Corporate Authors | European Conference on Infections in Leukaemia(ECIL), a joint venture of the European Group for Blood and Marrow Transplantation(EBMT), the European Organization for Research and Treatment of Cancer(EORTC), the Immunocompromised Host Society(ICHS) and, & European Conference on Infections in Leukaemia(ECIL), a joint venture |
Journal | J Antimicrob Chemother |
Volume | 73 |
Issue | 12 |
Pagination | 3221-3230 |
Date Published | 2018 12 01 |
ISSN | 1460-2091 |
Keywords | Adult, Antifungal Agents, Congresses as Topic, Europe, Hematologic Diseases, Hematopoietic Stem Cell Transplantation, Humans, Immunocompromised Host, Invasive Fungal Infections, Practice Guidelines as Topic, Randomized Controlled Trials as Topic, Risk Factors, Triazoles |
Abstract | The European Conference on Infections in Leukaemia (ECIL) updated its guidelines on antifungal prophylaxis for adults using the grading system of IDSA. The guidelines were extended to provide recommendations for other haematological diseases besides AML and recipients of an allogeneic haematopoietic stem cell transplantation (HSCT). Posaconazole remains the drug of choice when the incidence of invasive mould diseases exceeds 8%. For patients undergoing remission-induction chemotherapy for AML and myelodysplastic syndrome (MDS), fluconazole can still offer an alternative provided it forms part of an integrated care strategy that includes screening with biomarkers and imaging. Similarly, aerosolized liposomal amphotericin B combined with fluconazole can be considered for patients at high risk of invasive mould diseases but other formulations of the polyene are discouraged. Fluconazole is still recommended as primary prophylaxis for patients at low risk of invasive mould diseases during the pre-engraftment phase of allogeneic HSCT whereas only a moderate recommendation could be made for itraconazole, posaconazole and voriconazole for patients at high risk. Posaconazole is strongly recommended for preventing invasive mould disease post-engraftment but only when graft-versus-host disease (GvHD) was accompanied by other risk factors such as its severity, use of an alternative donor or when unresponsive to standard corticosteroid therapy. The need for primary prophylaxis for other patient groups was less clear and should be defined by the estimated risk of invasive fungal disease (IFD). |
DOI | 10.1093/jac/dky286 |
Alternate Journal | J Antimicrob Chemother |
PubMed ID | 30085172 |