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Boppana M, Sengar M, Jain H, Gurjar M, Ambotkar M, Gota V, Bonda A, Bagal B, Thorat J, Gokarn A, Nayak L, Shetty N, Baheti A, Mokal S, Kannan S, Shetty A, Eipe T. A Prospective Study to Evaluate the Effect of Therapeutic Drug Monitoring-Based Posaconazole Prophylaxis on Invasive Fungal Infection Rate During Acute Myeloid Leukemia Induction Therapy. Indian J Hematol Blood Transfus 2024; 40:204-212. [PMID: 38708158 PMCID: PMC11065854 DOI: 10.1007/s12288-023-01709-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/04/2023] [Indexed: 05/07/2024] Open
Abstract
Invasive fungal infections (IFIs) are a significant cause of morbidity and mortality in de-novo acute myeloid leukemia patients receiving induction chemotherapy. Despite using posaconazole, a broad-spectrum antifungal, for IFI prophylaxis, the breakthrough IFI rate is high in the real-world setting. One of the reasons could be frequent suboptimal plasma posaconazole levels. In the present study, we evaluated if therapeutic drug monitoring (TDM) guided posaconazole prophylaxis can reduce the IFI rates in comparison to a historical cohort. We enrolled 90 patients, > / = 16 years of age, without baseline IFIs, planned for remission induction therapy. All patients were started on posaconazole suspension 200 mg TDS and the dose was increased in a stepwise manner if trough levels were found to be suboptimal (< 350 ng/ml for day 2 or < 700 ng/ml subsequently). The TDM based approach resulted in a significant decline in breakthrough IFI rates (18% versus 52%, P < 0.0001) A total of 69 patients (78%) required dose escalation. Thirty-one patients required change in antifungals due to either suboptimal levels, persistent fever, diarrhoea or vomiting. We could not demonstrate an exposure-response relationship but the difference in IFI rates in patients with a median posaconazole level > / = 700 ng/ml (0%) and < 700 ng/ml (21.6%) was clinically meaningful. Posaconazole levels were found to be significantly lower in patients on antacids and prokinetics. The incidence of posaconazole-related grade 3 toxicity was low (2.3%). Thus TDM-based dosing of posaconazole helps reduce breakthrough IFI rate and should be a part of posaconazole prophylaxis. Supplementary Information The online version contains supplementary material available at 10.1007/s12288-023-01709-3.
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Affiliation(s)
- Mounika Boppana
- Department of Medical Oncology, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
- Present Address: Department of Medical Oncology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad, Telangana 500003, India
| | - Manju Sengar
- Adult Hematolymphoid Unit, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National University, Earnest Borges Road, Parel, Mumbai 400012 India
| | - Hasmukh Jain
- Adult Hematolymphoid Unit, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Murari Gurjar
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Madhavi Ambotkar
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Vikram Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Avinash Bonda
- Department of Medical Oncology, Asian Institute of Gastroenterology (AIG) Hospitals, Mindspace Road, P Janardhan Reddy Nagar, Gachibowli, Hyderabad, Telangana 500032, India
| | - Bhausaheb Bagal
- Adult Hematolymphoid Unit, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Jayashree Thorat
- Adult Hematolymphoid Unit, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Anant Gokarn
- Adult Hematolymphoid Unit, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Lingaraj Nayak
- Adult Hematolymphoid Unit, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Nitin Shetty
- Department of Radiodiagnosis, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Akshay Baheti
- Department of Radiodiagnosis, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Smruti Mokal
- Clinical Research Secretariat, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Sadhana Kannan
- Clinical Research Secretariat, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Alok Shetty
- Department of Medical Oncology, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
| | - Thomas Eipe
- Department of Medical Oncology, Tata Memorial Centre, Affiliated to Homi Bhabha National Institute, E Borges Road, Mumbai, Maharashtra 400 012 India
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Li S, Li Z, Wang P, Zhan Y, Xie J, Ye F. Efficacy and safety of caspofungin for the treatment of invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease. J Int Med Res 2024; 52:3000605241237878. [PMID: 38530040 DOI: 10.1177/03000605241237878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVES We assessed the efficacy of a 3-week primary or salvage caspofungin regimen in patients with chronic obstructive pulmonary disease (COPD) and concomitant proven or suspected invasive pulmonary aspergillosis (IPA). METHODS Forty-four patients were treated with an initial loading caspofungin dose of 70 mg, followed by a daily dose of 50 mg for 20 days. The main efficacy endpoint was clinical effectiveness. Secondary endpoints included the clinical efficacy of caspofungin after 1 week, therapeutic efficacy based on the European Organization for Research and Treatment of Cancer and Mycoses Study Group Education and Research Consortium (EORTC/MSG) criteria, the sensitivity of different Aspergillus strains to caspofungin in vitro, and the safety of caspofungin. RESULTS An assessment of 42 patients in the intention-to-treat group revealed efficacy rates of 33.33% within 1 week and 38.10% within 3 weeks. According to the EORTC/MSG criteria, the treatment success rate was 38.10%. The success rate of first-line treatment was 54.76%, whereas salvage treatment had a success rate of 45.24%. No adverse events were reported among the participants. CONCLUSIONS Caspofungin is effective and safe as an initial or salvage treatment for patients with IPA and COPD.
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Affiliation(s)
- Shaoqiang Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhengtu Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Penglei Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yangqing Zhan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiaxing Xie
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Feng Ye
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Soldi LR, Coelho YNB, Paranhos LR, Silva MJB. The impact of antifungal prophylaxis in patients diagnosed with acute leukemias undergoing induction chemotherapy: a systematic review and meta-analysis. Clin Exp Med 2023; 23:3231-3249. [PMID: 37058186 DOI: 10.1007/s10238-023-01062-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/29/2023] [Indexed: 04/15/2023]
Abstract
Acute leukemias are complex diseases to treat and have a high mortality rate. The immunosuppression caused by chemotherapy also causes the patient to become susceptible to a variety of infections, including invasive fungal infections. Protocols established in many countries attempt to prevent these infections through the use of pharmacological antifungal prophylaxis. This systematic review and meta-analysis investigates the existing evidence for the use of antifungal prophylaxis in patients undergoing induction chemotherapy for acute leukemia, and how prophylaxis can affect treatment response and mortality. Through the use of a population-variable-outcome strategy, keywords were utilized to search online databases. The included studies were selected and the data was collected to develop descriptive results for all studies, and, for studies that met the criteria, a meta-analysis of the Relative Risk (RR) was analyzed for infection rates, in-hospital mortality, and complete remission. A total of 33 studies were included in this systematic review, with most studies presenting positive results (n = 28/33) from the use of antifungal prophylaxis. Using a random effects model, the pooled results of the meta-analysis presented lower invasive fungal infections in AML (RR: 0.527 (95% CI: 0.391; 0.709). p < 0.001). p < 0.001) and ALL (RR: 0.753 (95% CI: 0.574; 0.988). p = 0.041). when antifungal prophylaxis was used. No discernible difference was encountered in the rate of complete remission when using prophylaxis. Antifungal prophylaxis provides a lower risk of invasive fungal infections and in-hospital mortality in acute leukemia patients undergoing induction chemotherapy.
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Affiliation(s)
- Luiz Ricardo Soldi
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.
- Tumor Biomarkers and Osteoimmunology Laboratory, Av. Pará - 1720 - Block 6T, Room 07 - District Umuarama, Uberlândia, Minas Gerais, Brazil.
- Student of the Graduate Program in Applied Immunology and Parasitology, Universidade Federal de Uberlândia, Uberlândia, Brazil.
| | - Yasmin Nascimento Bernardes Coelho
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
- Student of the Graduate Program in Applied Immunology and Parasitology, Universidade Federal de Uberlândia, Uberlândia, Brazil
| | - Luiz Renato Paranhos
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Marcelo José Barbosa Silva
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
- Tumor Biomarkers and Osteoimmunology Laboratory, Av. Pará - 1720 - Block 6T, Room 07 - District Umuarama, Uberlândia, Minas Gerais, Brazil
- Professor responsible for the area of Immunology at the Institute of Biomedical Sciences, Universidade Federal de Uberlândia, Uberlândia, Brazil
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Lewis RE, Kontoyiannis DP. Chimeric Antigen Receptor T-cell Immunotherapy and Need for Prophylaxis for Invasive Mold Infections. Clin Infect Dis 2021; 71:1802-1803. [PMID: 31927567 DOI: 10.1093/cid/ciaa031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Russell E Lewis
- Infectious Diseases, S. Orsola-Malpighi, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Miesel L, Cushion MT, Ashbaugh A, Lopez SR, Ong V. Efficacy of Rezafungin in Prophylactic Mouse Models of Invasive Candidiasis, Aspergillosis, and Pneumocystis Pneumonia. Antimicrob Agents Chemother 2021; 65:e01992-20. [PMID: 33318018 PMCID: PMC8092522 DOI: 10.1128/aac.01992-20] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/07/2020] [Indexed: 12/19/2022] Open
Abstract
Antifungal prophylaxis is recommended to prevent invasive fungal disease caused by Candida spp., Aspergillus spp., and Pneumocystis jirovecii in patients at risk for opportunistic infections, such as allogeneic blood or marrow transplant recipients, patients with hematological disease undergoing chemotherapy, or patients on immunosuppressive therapies. Current approaches to antifungal prophylaxis require multiple agents to cover these key fungi. Rezafungin, a novel echinocandin designed for next-generation properties (e.g., greater stability and long-acting pharmacokinetics for once-weekly dosing), has demonstrated in vitro activity against Candida and Aspergillus spp. and efficacy against Pneumocystis spp. biofilms. Rezafungin was evaluated in in vivo studies of prophylactic efficacy using immunosuppressed mouse models of invasive candidiasis, aspergillosis, and Pneumocystis pneumonia. Rezafungin reduction of Candida CFU burden was generally greater with increasing drug concentrations (5, 10, or 20 mg/kg) and when rezafungin was administered closer to the time of fungal challenge (day -1, -3, or -5). Similarly, in the aspergillosis model, survival rates increased with drug concentrations and when rezafungin was administered closer to the time of fungal challenge. Against Pneumocystismurina, rezafungin significantly reduced trophic nuclei and asci counts at all doses tested. Rezafungin prevented infection at the two higher doses compared to vehicle and had comparable activity to the active control trimethoprim-sulfamethoxazole at human equivalent doses for prevention. These findings support phase 3 development of rezafungin and the potential for single-agent prophylaxis against invasive fungal disease caused by Candida spp., Aspergillus spp., and Pneumocystis jirovecii.
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Affiliation(s)
- Lynn Miesel
- Pharmacology Discovery Services, Taipei, Taiwan
| | - Melanie T Cushion
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Cincinnati VAMC, Cincinnati, Ohio, USA
| | - Alan Ashbaugh
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Cincinnati VAMC, Cincinnati, Ohio, USA
| | | | - Voon Ong
- Cidara Therapeutics, Inc., San Diego, California, USA
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Busca A, Cattaneo C, De Carolis E, Nadali G, Offidani M, Picardi M, Candoni A, Ceresoli E, Criscuolo M, Delia M, Della Pepa R, Del Principe I, Fanci RR, Farina F, Fracchiolla N, Giordano C, Malagola M, Marchesi F, Piedimonte M, Prezioso L, Quinto AM, Spolzino A, Tisi MC, Trastulli F, Trecarichi EM, Zappasodi P, Tumbarello M, Pagano L. Considerations on antimicrobial prophylaxis in patients with lymphoproliferative diseases: A SEIFEM group position paper. Crit Rev Oncol Hematol 2020; 158:103203. [PMID: 33388453 DOI: 10.1016/j.critrevonc.2020.103203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/15/2020] [Accepted: 12/20/2020] [Indexed: 11/16/2022] Open
Abstract
The therapeutic armamentarium for the treatment of patients with lymphoproliferative diseases has grown considerably over the most recent years, including a large use of new immunotherapeutic agents. As a consequence, the epidemiology of infectious complications in this group of patients is poorly documented, and even more importantly, the potential benefit of antimicrobial prophylaxis remains a matter of debate when considering the harmful effect from the emergence of multidrug resistant pathogens. The present position paper is addressed to all hematologists treating patients affected by lymphoproliferative malignancies with the aim to provide clinicians with a useful tool for the prevention of bacterial, fungal and viral infections.
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Affiliation(s)
- Alessandro Busca
- Stem Cell Transplant Center, AOU Citta' della Salute e della Scienza, Turin, Italy.
| | - Chiara Cattaneo
- Divisione di Ematologia, ASST-Spedali Civili di Brescia, Brescia, Chiara, Italy.
| | - Elena De Carolis
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
| | - Gianpaolo Nadali
- U.O.C. Ematologia, AOU Integrata di Verona, Ospedale Borgo Roma, Verona, Italy.
| | - Massimo Offidani
- Clinica di Ematologia, AOU Ospedali Riuniti di Ancona, Ancona, Italy.
| | - Marco Picardi
- Department of Advanced Biomedical Science, Federico II University, Italy.
| | - Anna Candoni
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari, Azienda Sanitaria Universitaria Integrata di Udine, Italy.
| | - Eleonora Ceresoli
- Ematologia Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy.
| | - Marianna Criscuolo
- Dipartimento di scienze radiologiche, radioterapiche ed ematologiche Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Italy.
| | - Mario Delia
- U.O.: Ematologia con Trapianto Azienda Ospedaliero-Universitaria Dipartimento dell'Emergenza e Dei Trapianti di Organo Policlinico di Bari, Italy.
| | - Roberta Della Pepa
- Department of Clinical Medicine and Surgery", University of Federico II Naples, Italy.
| | - Ilaria Del Principe
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università degli studi di Roma "Tor Vergata", Italy.
| | - Roma Rosa Fanci
- Hematology Department, Careggi Hospital and University of Florence, Italy.
| | - Francesca Farina
- U.O. Ematologia e Trapianto di Midollo - IRCCS Ospedale San Raffaele, Milano, Italy.
| | - Nicola Fracchiolla
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Italy.
| | - Claudia Giordano
- Department of Clinical Medicine and Surgery", University of Federico II Naples, Italy.
| | - Michele Malagola
- Department of Clinical and Experimental Sciences, University of Brescia, Bone Marrow Transplant Unit, ASST Spedali Civili of Brescia, Italy.
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
| | - Monica Piedimonte
- Department of Clinical and Molecular Medicine, Hematology Sant'Andrea University Hospital, Sapienza University of Rome, Italy.
| | - Lucia Prezioso
- Hematology and BMT Unit, Azienda Ospedaliero-Universitaria di Parma and Department of Medicine and Surgery, University of Parma, Italy.
| | - Angela Maria Quinto
- UO Ematologia e Terapia Cellulare, IRCCS - Istituto Tumori "Giovanni Paolo II" Bari, Italy.
| | - Angelica Spolzino
- Department of Clinical and Molecular Medicine, Hematology Sant'Andrea University Hospital, Sapienza University of Rome, Italy.
| | | | - Fabio Trastulli
- Department of Clinical Medicine and Surgery", University of Federico II Naples, Italy.
| | - Enrico Maria Trecarichi
- Dipartimento di Scienze Mediche e Chirurgiche, UO Malattie Infettive e Tropicali, Università degli Studi "Magna Graecia", Catanzaro, Italy.
| | - Patrizia Zappasodi
- Division of Hematology, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Mario Tumbarello
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - Istituto di Malattie Infettive -Università Cattolica del Sacro Cuore, Livio, Italy.
| | - Livio Pagano
- Fondazione Policlinico Universitario A. Gemelli - IRCCS - Istituto di Malattie Infettive -Università Cattolica del Sacro Cuore, Livio, Italy.
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Paige E, Thursky K, Slavin M. Mold-active prophylaxis in acute leukemia: not enough of a good thing? . Leuk Lymphoma 2019; 60:2851-2853. [PMID: 31335251 DOI: 10.1080/10428194.2019.1641804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Emma Paige
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia
| | - Karin Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,NHMRC National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,NHMRC National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Monica Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,NHMRC National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Warris A, Lehrnbecher T, Roilides E, Castagnola E, Brüggemann RJM, Groll AH. ESCMID-ECMM guideline: diagnosis and management of invasive aspergillosis in neonates and children. Clin Microbiol Infect 2019; 25:1096-1113. [PMID: 31158517 DOI: 10.1016/j.cmi.2019.05.019] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 05/19/2019] [Accepted: 05/23/2019] [Indexed: 01/01/2023]
Abstract
SCOPE Presenting symptoms, distributions and patterns of diseases and vulnerability to invasive aspergillosis (IA) are similar between children and adults. However, differences exist in the epidemiology and underlying conditions, the usefulness of newer diagnostic tools, the pharmacology of antifungal agents and in the evidence from interventional phase 3 clinical trials. Therefore, the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) and the European Confederation of Medical Mycology (ECMM) have developed a paediatric-specific guideline for the diagnosis and management of IA in neonates and children. METHODS Review and discussion of the scientific literature and grading of the available quality of evidence was performed by the paediatric subgroup of the ESCMID-ECMM-European Respiratory Society (ERS) Aspergillus disease guideline working group, which was assigned the mandate for the development of neonatal- and paediatric-specific recommendations. QUESTIONS Questions addressed by the guideline included the epidemiology of IA in neonates and children; which paediatric patients may benefit from antifungal prophylaxis; how to diagnose IA in neonates and children; which antifungal agents are available for use in neonates and children; which antifungal agents are suitable for prophylaxis and treatment of IA in neonates and children; what is the role of therapeutic drug monitoring of azole antifungals; and which management strategies are suitable to be used in paediatric patients. This guideline provides recommendations for the diagnosis, prevention and treatment of IA in the paediatric population, including neonates. The aim of this guideline is to facilitate optimal management of neonates and children at risk for or diagnosed with IA.
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Affiliation(s)
- A Warris
- MRC Centre for Medical Mycology, Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom; European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology, the Netherlands.
| | - T Lehrnbecher
- Division of Paediatric Haematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany; European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology, the Netherlands
| | - E Roilides
- Infectious Diseases Unit, 3rd Department of Paediatrics, Faculty of Medicine, Aristotle University 96 School of Health Sciences, Thessaloniki, Greece; European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology, the Netherlands
| | - E Castagnola
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini Children's Hospital, Genoa, Italy; European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group (EFISG)
| | - R J M Brüggemann
- Radboud Center for Infectious Diseases, Radboud University Medical Centre, Center of Expertise in Mycology Radboudumc/CWZ, European Confederation of Medical Mycology (ECMM) Excellence Center of Medical Mycology, Nijmegen, the Netherlands; European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group (EFISG)
| | - A H Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Paediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany; European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology, the Netherlands
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9
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Busca A, Pagano L. Prophylaxis for aspergillosis in patients with haematological malignancies: pros and cons. Expert Rev Anti Infect Ther 2018; 16:531-542. [DOI: 10.1080/14787210.2018.1496329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Alessandro Busca
- Stem Cell Transplant Center, AOU Citta’ della Salute e Della Scienza, Turin, Italy
| | - Livio Pagano
- Institute of Hematology, Policlinico Universitario Agostino Gemelli, Rome, Italy
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10
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Epstein DJ, Seo SK, Huang YT, Park JH, Klimek VM, Berman E, Tallman MS, Frattini MG, Papanicolaou GA. Micafungin versus posaconazole prophylaxis in acute leukemia or myelodysplastic syndrome: A randomized study. J Infect 2018; 77:227-234. [PMID: 29746955 DOI: 10.1016/j.jinf.2018.03.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/02/2018] [Accepted: 03/04/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To compare the effectiveness and tolerability of micafungin versus posaconazole during chemotherapy-induced neutropenia in acute leukemia (AL) and myelodysplastic syndrome (MDS). METHODS Patients with AL or MDS undergoing chemotherapy were randomized to open-label micafungin 100 mg intravenously daily or posaconazole suspension 400 mg orally twice daily until neutrophil recovery, up to 28 days. Patients were followed for 12 weeks. The primary endpoint was prophylaxis failure (premature discontinuation due to infection, intolerance, adverse event, or death). Time to failure and survival were calculated by Kaplan-Meier analysis. RESULTS From March 2011 to May 2016, 113 patients who received at least 2 doses of prophylaxis were analyzed (58 patients randomized to micafungin and 55 to posaconazole). Prophylaxis failure occurred in 34.5% and 52.7% of patients on micafungin and posaconazole, respectively (P = 0.0118). The median number of days on prophylaxis was 16 [interquartile range (IQR) 12-20] for micafungin and 13 [IQR 6-16] for posaconazole (P = 0.01). Micafungin failures were largely due to antifungal treatment; posaconazole failures were mostly due to gastrointestinal intolerance or adverse effects. IFI incidence and survival were similar between study arms. CONCLUSIONS Our data support micafungin as alternative antifungal prophylaxis in patients with AL and MDS.
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Affiliation(s)
- David J Epstein
- Infectious Disease Service, Division of Subspecialty Medicine, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Susan K Seo
- Infectious Disease Service, Division of Subspecialty Medicine, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Yao-Ting Huang
- Infectious Disease Service, Division of Subspecialty Medicine, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Jay H Park
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA; Leukemia Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Virginia M Klimek
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA; Leukemia Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Ellin Berman
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA; Leukemia Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Martin S Tallman
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA; Leukemia Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Mark G Frattini
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA; Leukemia Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Genovefa A Papanicolaou
- Infectious Disease Service, Division of Subspecialty Medicine, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
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11
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The burden of Invasive Aspergillosis in patients with haematological malignancy: A meta-analysis and systematic review. J Infect 2018; 76:550-562. [PMID: 29727605 DOI: 10.1016/j.jinf.2018.02.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/13/2018] [Accepted: 02/16/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Successful treatment of haematological malignancies is frequently complicated by Invasive Aspergillosis (IA), a life-threatening fungal infection that occurs in at least 10% of haemato-oncological patients. Case fatality rates (CFR) may fluctuate over time, depending on host pathogen interactions as well as on treatment and quality of patient care. We conducted a systematic review and metaanalysis of current - i.e. 2008-revised EORTC-MSG criteria era - incidence and case fatality rates (CFR) of IA in patients with haematological malignancy. METHODS A systematic search according to PRISMA guidelines was performed to identify all literature reporting populations with a haematological malignancy and the incidence of IA, defined according to the EORTC/MSG 2008 criteria. Pooled cumulative incidences and CFR within 100 days were estimated using a random effects model for predefined patient populations and stratified by use of prophylaxis. RESULTS The systematic literature search yielded 1285 publications of which n = 49 met the inclusion criteria. Overall, 16.815 patients were involved of which 1056 (6.3%) developed IA. IA risk ranged from 4% (during remission-induction, with prophylaxis) to 11% (during remission-induction, without prophylaxis). Antifungal prophylaxis was associated with a lower rate of IA, especially in the pre-HSCT population. The pooled CFR within 100 days was 29% (95% CI: 20-38%). DISCUSSION This study confirms that IA is a relevant threat in the treatment of haematological cancer despite the universal use of antifungal prophylaxis. These outcomes inform scientists and other stakeholders about the current burden of IA and may be used to direct, implement and improve antifungal stewardship programs.
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12
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Epstein DJ, Seo SK, Brown JM, Papanicolaou GA. Echinocandin prophylaxis in patients undergoing haematopoietic cell transplantation and other treatments for haematological malignancies. J Antimicrob Chemother 2018; 73:i60-i72. [PMID: 29304213 PMCID: PMC7189969 DOI: 10.1093/jac/dkx450] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Antifungal prophylaxis is the standard of care for patients undergoing intensive chemotherapy for haematological malignancy or haematopoietic cell transplantation (HCT). Prophylaxis with azoles reduces invasive fungal infections and may reduce mortality. However, breakthrough infections still occur, and the use of azoles is sometimes complicated by pharmacokinetic variability, drug interactions, adverse events and other issues. Echinocandins are highly active against Candida species, including some organisms resistant to azoles, and have some clinical activity against Aspergillus species as well. Although currently approved echinocandins require daily intravenous administration, the drugs have a favourable safety profile and more predictable pharmacokinetics than mould-active azoles. Clinical data support the efficacy and safety of echinocandins for antifungal prophylaxis in haematology and HCT patients, though data are less robust than for azoles. Notably, sparse evidence exists supporting the use of echinocandins as antifungal prophylaxis for patients with significant graft-versus-host disease (GvHD) after HCT. Two drugs that target (1,3)-β-d-glucan are in development, including an oral glucan synthase inhibitor and an echinocandin with unique pharmacokinetics permitting subcutaneous and weekly administration. Echinocandins are a reasonable alternative to azoles and other agents for antifungal prophylaxis in patients undergoing intensive chemotherapy for haematological malignancy or those receiving HCT, excluding those with significant GvHD.
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Affiliation(s)
- David J Epstein
- Division of Infectious Diseases, Stanford University, Palo Alto, CA, USA
| | - Susan K Seo
- Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Janice M Brown
- Division of Infectious Diseases, Stanford University, Palo Alto, CA, USA
| | - Genovefa A Papanicolaou
- Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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13
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Challenges and Solution of Invasive Aspergillosis in Non-neutropenic Patients: A Review. Infect Dis Ther 2017; 7:17-27. [PMID: 29273978 PMCID: PMC5840102 DOI: 10.1007/s40121-017-0183-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Indexed: 12/31/2022] Open
Abstract
Invasive aspergillosis (IA) is a serious opportunistic infection, which has increasingly been recognized as an emerging disease of non-neutropenic patients. In this group of patients, the diagnosis of IA can be challenging owing to the lack of specificity of symptoms, the difficulty in discriminating colonization from infection, and the lower sensitivity of microbiological and radiological tests compared with immunocompromised patients. The aim of this article is to present to clinicians a critical review on the management of IA in non-neutropenic patients.
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14
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Real-Life Challenges to the Use of Antifungal Agents in Hematology Patients. CURRENT FUNGAL INFECTION REPORTS 2017. [DOI: 10.1007/s12281-017-0303-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Abstract
PURPOSE OF REVIEW Improved management of infectious complications of acute myeloid leukemia (AML) has contributed substantially to the success of care over the past half century. An important approach to reducing infectious complications during the induction period of chemotherapy involves the use of prophylactic antibacterial, antiviral, and antifungal agents targeting likely pathogens. RECENT FINDINGS There is not a one-size-fits-all approach to prophylaxis; every patient undergoing induction therapy should be evaluated individually and within the context of local microbiologic epidemiology and host risk factors. Pharmacologic and non-pharmacologic interventions as well as novel diagnostic platforms can help mitigate the risk of life-threatening infection in patients with AML who undergo induction chemotherapy.
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Affiliation(s)
- Matthew W McCarthy
- Division of General Internal Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, Box 331, New York, NY, 10065, USA.
| | - Thomas J Walsh
- Transplantation-Oncology Infectious Diseases Program, Medical Mycology Research Laboratory, Weill Cornell Medical Center, New York, NY, USA
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16
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Maximova N, Schillani G, Simeone R, Maestro A, Zanon D. Comparison of Efficacy and Safety of Caspofungin Versus Micafungin in Pediatric Allogeneic Stem Cell Transplant Recipients: A Retrospective Analysis. Adv Ther 2017; 34:1184-1199. [PMID: 28429246 DOI: 10.1007/s12325-017-0534-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The high morbidity and mortality associated with invasive fungal infections (IFIs) provide the rationale for antifungal prophylaxis in immuno-compromised pediatric patients undergoing hematopoietic stem cell transplantation (HSCT). Caspofungin and micafungin are antifungal agents of interest for prophylaxis of IFIs because of their potency against Candida and minimal toxicity or interactions with other drugs. Few studies have demonstrated the safety and efficacy of such echinocandins as prophylaxis for IFIs in patients undergoing HSCT. METHODS This retrospective cohort study compared caspofungin and micafungin for prevention of IFIs in 93 pediatric patients undergoing HSCT for oncological or non-oncological disease. The observation began with the first dose of antifungal agent and ended 3 months after transplantation. RESULTS Patients in the micafungin group had a higher overall treatment success rate of 87.2 versus 84.8% in the caspofungin group, but the difference was not significant. There were no statistically significant differences in the incidence or type of proven/probable IFIs between the 2 groups. The low incidence of death did not differ statistically between the groups. Patients in the caspofungin group presented more frequently with fever, during and after neutropenia. In both groups, we observed an expected worsening of blood chemistry parameters. There were no adverse events definitely attributable to the two antifungal agents. CONCLUSION These results demonstrate good efficacy and tolerability for caspofungin and micafungin. However, better results with respect to the incidence and resolution of fever in the micafungin group may suggest its use in preference to that of caspofungin.
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Affiliation(s)
- Natalia Maximova
- Bone Marrow Transplantation Unit, Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy.
| | - Giulia Schillani
- Bone Marrow Transplantation Unit, Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - Roberto Simeone
- Department of Transfusion Medicine, Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - Alessandra Maestro
- Pharmacy and Clinical Pharmacology Unit, Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - Davide Zanon
- Pharmacy and Clinical Pharmacology Unit, Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
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17
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Pagano L, Busca A, Candoni A, Cattaneo C, Cesaro S, Fanci R, Nadali G, Potenza L, Russo D, Tumbarello M, Nosari A, Aversa F. Risk stratification for invasive fungal infections in patients with hematological malignancies: SEIFEM recommendations. Blood Rev 2016; 31:17-29. [PMID: 27682882 DOI: 10.1016/j.blre.2016.09.002] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/05/2016] [Accepted: 09/09/2016] [Indexed: 11/17/2022]
Abstract
Invasive fungal infections (IFIs) are an important cause of morbidity and mortality in immunocompromised patients. Patients with hematological malignancies undergoing conventional chemotherapy, autologous or allogeneic hematopoietic stem cell transplantation are considered at high risk, and Aspergillus spp. represents the most frequently isolated micro-organisms. In the last years, attention has also been focused on other rare molds (e.g., Zygomycetes, Fusarium spp.) responsible for devastating clinical manifestations. The extensive use of antifungal prophylaxis has reduced the infections from yeasts (e.g., candidemia) even though they are still associated with high mortality rates. This paper analyzes concurrent multiple predisposing factors that could favor the onset of fungal infections. Although neutropenia is common to almost all hematologic patients, other factors play a key role in specific patients, in particular in patients with AML or allogeneic HSCT recipients. Defining those patients at higher risk of IFIs may help to design the most appropriate diagnostic work-up and antifungal strategy.
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Affiliation(s)
- Livio Pagano
- Istituto di Ematologia, Università Cattolica S. Cuore, Roma, Italy.
| | - Alessandro Busca
- Stem Cell Transplant Center, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Anna Candoni
- Clinica Ematologica, Azienda Ospedaliero-Universitaria Santa Maria Misericordia, Udine, Italy
| | | | - Simone Cesaro
- Oncoematologia Pediatrica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Rosa Fanci
- Unità Funzionale di Ematologia, Azienda Ospedaliero-Universitaria Careggi e Università di Firenze, Italy
| | - Gianpaolo Nadali
- Unità Operativa Complessa di Ematologia, Azienda Ospedaliera Universitaria Integrata di Verona, Italy
| | - Leonardo Potenza
- UOC Ematologia, Dipartimento di Scienze Mediche e Chirurgiche Materno Infantili e dell'Adulto, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Domenico Russo
- Cattedra di Ematologia, Unità di Malattie del Sangue e Trapianto di Midollo Osseo, Dipartimento di Scienze Cliniche e Sperimentali, Università di Brescia e ASST Spedali Civili, Brescia, Italy
| | - Mario Tumbarello
- Istituto di Malattie Infettive, Università Cattolica S. Cuore, Roma, Italy
| | - Annamaria Nosari
- Divisione di Ematologia e Centro Trapianti Midollo, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Franco Aversa
- Hematology and BMT Unit, Department of Clinical and Experimental Medicine, University of Parma, Italy
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18
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Patterson TF, Thompson GR, Denning DW, Fishman JA, Hadley S, Herbrecht R, Kontoyiannis DP, Marr KA, Morrison VA, Nguyen MH, Segal BH, Steinbach WJ, Stevens DA, Walsh TJ, Wingard JR, Young JAH, Bennett JE. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 63:e1-e60. [PMID: 27365388 DOI: 10.1093/cid/ciw326] [Citation(s) in RCA: 1574] [Impact Index Per Article: 196.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 05/11/2016] [Indexed: 12/12/2022] Open
Abstract
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
- Thomas F Patterson
- University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System
| | | | - David W Denning
- National Aspergillosis Centre, University Hospital of South Manchester, University of Manchester, United Kingdom
| | - Jay A Fishman
- Massachusetts General Hospital and Harvard Medical School
| | | | | | | | - Kieren A Marr
- Johns Hopkins University School of Medicine and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Vicki A Morrison
- Hennepin County Medical Center and University of Minnesota, Minneapolis
| | | | - Brahm H Segal
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, and Roswell Park Cancer Institute, New York
| | | | | | - Thomas J Walsh
- New York-Presbyterian Hospital/Weill Cornell Medical Center, New York
| | | | | | - John E Bennett
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland
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19
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Venton G, Adam H, Colle J, Labiad Y, Mercier C, Ivanov V, Suchon P, Fanciullino R, Farnault L, Costello R. Micafungin as primary antifungal prophylaxis in patients presenting with acute myeloid leukemia. Med Mal Infect 2016; 46:226-9. [PMID: 27126350 DOI: 10.1016/j.medmal.2016.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 01/29/2016] [Accepted: 03/18/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To study the efficacy and safety of micafungin for prophylaxis of invasive fungal infections in patients undergoing induction chemotherapy for acute myeloid leukemia. PATIENTS AND METHODS A prospective observational single-center study of 41 patients from the hematology department between May 2012 and April 2015. Micafungin was administered once daily from the first day of induction chemotherapy to the end of the neutropenic phase. RESULTS Neither Candida nor Aspergillus infection was documented in our 41 patients from the first day of micafungin infusion to the end of the neutropenic phase. Patients were followed for three months after discontinuation of micafungin and none of them contracted an invasive fungal infection. Only one patient presented with grade III-IV hepatic and ionic toxicities. CONCLUSION Micafungin is associated with a good safety profile and is an interesting option for preventing invasive fungal infections in the high-risk population of patients presenting with hematological disorders.
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Affiliation(s)
- G Venton
- Inserm, UMR1090 TAGC, 13288 Marseille, France; Aix-Marseille université, UMR1090 TAGC, 13288 Marseille, France; Service d'hématologie et de thérapie cellulaire AP-HM, hôpital de la Conception, Marseille, France
| | - H Adam
- Unité pharmacie hospitalière hôpital de la Conception, Marseille, France
| | - J Colle
- Inserm, UMR1090 TAGC, 13288 Marseille, France; Aix-Marseille université, UMR1090 TAGC, 13288 Marseille, France; Service d'hématologie et de thérapie cellulaire AP-HM, hôpital de la Conception, Marseille, France
| | - Y Labiad
- Inserm, UMR1090 TAGC, 13288 Marseille, France; Aix-Marseille université, UMR1090 TAGC, 13288 Marseille, France
| | - C Mercier
- Service d'hématologie et de thérapie cellulaire AP-HM, hôpital de la Conception, Marseille, France; UMR-911 Inserm laboratoire de toxicocinétique et pharmacocinétique, faculté de pharmacie, Marseille, France
| | - V Ivanov
- Service d'hématologie et de thérapie cellulaire AP-HM, hôpital de la Conception, Marseille, France
| | - P Suchon
- Laboratoire d'hématologie, AP-HM, hôpital de la Timone, Marseille, France; UMR 1062 NORT, Inserm, Marseille, France
| | - R Fanciullino
- UMR-911 Inserm laboratoire de toxicocinétique et pharmacocinétique, faculté de pharmacie, Marseille, France; Unité pharmacie hospitalière hôpital de la Conception, Marseille, France
| | - L Farnault
- Service d'hématologie et de thérapie cellulaire AP-HM, hôpital de la Conception, Marseille, France
| | - R Costello
- Inserm, UMR1090 TAGC, 13288 Marseille, France; Aix-Marseille université, UMR1090 TAGC, 13288 Marseille, France; Service d'hématologie et de thérapie cellulaire AP-HM, hôpital de la Conception, Marseille, France.
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20
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Douglas AP, Thursky KA, Slavin MA. Invasive fungal infections in ALL: a new 'growth' area. Leuk Lymphoma 2016; 57:1985-7. [PMID: 27124301 DOI: 10.1080/10428194.2016.1177775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Abby P Douglas
- a Department of Infectious Diseases , Peter MacCallum Cancer Centre , East Melbourne , Victoria , Australia
| | - Karin A Thursky
- a Department of Infectious Diseases , Peter MacCallum Cancer Centre , East Melbourne , Victoria , Australia ;,b Victorian Infectious Diseases Service , Royal Melbourne Hospital , Melbourne , Victoria , Australia ;,c The Peter Doherty Institute for Infection and Immunity , Melbourne , Victoria , Australia ;,d Department of Medicine, University of Melbourne , Melbourne , Victoria , Australia
| | - Monica A Slavin
- a Department of Infectious Diseases , Peter MacCallum Cancer Centre , East Melbourne , Victoria , Australia ;,b Victorian Infectious Diseases Service , Royal Melbourne Hospital , Melbourne , Victoria , Australia ;,c The Peter Doherty Institute for Infection and Immunity , Melbourne , Victoria , Australia ;,d Department of Medicine, University of Melbourne , Melbourne , Victoria , Australia
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21
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Primary antifungal prophylaxis during curative-intent therapy for acute myeloid leukemia. Blood 2015; 126:2790-7. [PMID: 26504183 DOI: 10.1182/blood-2015-07-627323] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/21/2015] [Indexed: 11/20/2022] Open
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22
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Kiehl MG, Egerer G, Engelhardt M, Gross B. Empirical caspofungin therapy in clinical practice for suspected invasive fungal disease in adults with acute lymphoblastic leukaemia. Mycoses 2015; 58:76-81. [PMID: 25590660 DOI: 10.1111/myc.12277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 10/29/2014] [Accepted: 11/05/2014] [Indexed: 11/27/2022]
Abstract
Patients with acute lymphoblastic leukaemia (ALL) after cytotoxic chemotherapy or haematopoietic stem cell transplantation (HSCT) are at risk for life-threatening invasive fungal disease (IFD). The aim was to evaluate the characteristics, antifungal therapy and outcome of adult patients with ALL after chemotherapy or HSCT receiving caspofungin empirically in a clinical setting. Retrospective chart reviews were conducted at nine large tertiary care centres in Germany. Adult patients with ALL treated empirically with caspofungin according to the product label between 2006 and 2012 were eligible. Data were extracted as case reports. In total, 25 patients (12 males, 13 females; median age 37 years; 19 with B-ALL, 6 with T-ALL) with 28 treatment episodes because of suspected IFD (18 episodes after chemotherapy, 10 episodes after allogeneic HSCT) were included in the analysis. Empirical caspofungin therapy (median duration: 19 days, range 1-105 days) was given as first-line monotherapy in 20 (71.4%), second-line monotherapy in five (17.9%) and combination therapy in three (10.7%) episodes respectively. Therapy rated successful according to the physician's overall assessment (inflammatory parameters, clinical symptoms): 20 (95%) of 21 evaluable episodes with therapy duration of at least 8 days. Empirical caspofungin appears to be an effective therapeutic option in critically ill adult ALL patients with suspected IFD in clinical practice.
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Affiliation(s)
- Michael G Kiehl
- Medical Department I, Frankfurt/Oder General Hospital, Frankfurt (Oder), Germany
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23
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Fleming S, Yannakou CK, Haeusler GM, Clark J, Grigg A, Heath CH, Bajel A, van Hal SJ, Chen SC, Milliken ST, Morrissey CO, Tam CS, Szer J, Weinkove R, Slavin MA. Consensus guidelines for antifungal prophylaxis in haematological malignancy and haemopoietic stem cell transplantation, 2014. Intern Med J 2014; 44:1283-97. [DOI: 10.1111/imj.12595] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S. Fleming
- Malignant Haematology and Stem Cell Transplantation Service; Alfred Health; Prahran Victoria
| | - C. K. Yannakou
- Department of Clinical Haematology and Bone Marrow Transplant Service; The Royal Melbourne Hospital; Parkville Victoria
| | - G. M. Haeusler
- Department of Infectious Diseases and Infection Control; Peter MacCallum Cancer Centre; East Melbourne Victoria
- Department of Paediatric Infectious Diseases; Monash Children's Hospital; Monash Health; Clayton Victoria
- Paediatric Integrated Cancer Service; Parkville Victoria
| | - J. Clark
- Infection Management and Prevention Service; The Royal Children's Hospital Brisbane; Queensland Health; Herston Queensland
| | - A. Grigg
- Department of Clinical Haematology; Austin Health; Heidelberg Victoria
- School of Medicine; The University of Melbourne; Melbourne Victoria
| | - C. H. Heath
- Department of Microbiology and Infectious Diseases; Royal Perth Hospital; Perth Western Australia
- School of Medicine and Pharmacology (RPH Unit); University of Western Australia; Perth Western Australia
| | - A. Bajel
- Department of Clinical Haematology and Bone Marrow Transplant Service; The Royal Melbourne Hospital; Parkville Victoria
| | - S. J. van Hal
- Department of Microbiology and Infectious Diseases; Royal Prince Alfred Hospital; Camperdown New South Wales
| | - S. C. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services; ICPMR - Pathology West; Westmead New South Wales
- Department of Infectious Diseases; Westmead Hospital; Westmead New South Wales
- Sydney Medical School; The University of Sydney; Sydney New South Wales
| | - S. T. Milliken
- Department of Haematology; St Vincent's Hospital; Darlinghurst New South Wales
- Faculties of Medicine and Pathology; The University of NSW; Kensington New South Wales
| | - C. O. Morrissey
- Department of Infectious Diseases; Alfred Health and Monash University; Prahran Victoria
- Department of Clinical Haematology; Alfred Health; Prahran Victoria
| | - C. S. Tam
- School of Medicine; The University of Melbourne; Melbourne Victoria
- Department of Haematology; Peter MacCallum Cancer Centre; East Melbourne Victoria
| | - J. Szer
- Department of Clinical Haematology and Bone Marrow Transplant Service; The Royal Melbourne Hospital; Parkville Victoria
- School of Medicine; The University of Melbourne; Melbourne Victoria
| | - R. Weinkove
- Wellington Blood and Cancer Centre; Capital and Coast District Health Board; Wellington New Zealand
- Vaccine Research Group; Malaghan Institute of Medical Research; Wellington New Zealand
| | - M. A. Slavin
- Department of Infectious Diseases and Infection Control; Peter MacCallum Cancer Centre; East Melbourne Victoria
- School of Medicine; The University of Melbourne; Melbourne Victoria
- Victorian Infectious Diseases Service; The Doherty Institute for Infection and Immunity; Parkville Victoria
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24
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Tacke D, Buchheidt D, Karthaus M, Krause SW, Maschmeyer G, Neumann S, Ostermann H, Penack O, Rieger C, Ruhnke M, Sandherr M, Schweer KE, Ullmann AJ, Cornely OA. Primary prophylaxis of invasive fungal infections in patients with haematologic malignancies. 2014 update of the recommendations of the Infectious Diseases Working Party of the German Society for Haematology and Oncology. Ann Hematol 2014; 93:1449-56. [PMID: 24951122 DOI: 10.1007/s00277-014-2108-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 05/09/2014] [Indexed: 10/25/2022]
Abstract
Invasive fungal infections cause substantial morbidity and mortality in immunocompromised patients, particularly in those with haematological malignancies and recipients of allogeneic haematopoietic stem cell transplantation. Difficulties in diagnosing invasive fungal infections and subsequent delays in treatment initiation lead to unfavourable outcomes and emphasise the importance of prophylaxis. Since the recommendations of the Infectious Diseases Working Party of the German Society for Haematology and Oncology in 2009, results of 14 additional clinical studies have been published comprising 2,899 patients and initiating this update. Key recommendations for adult patients are as follows: Posaconazole remains the drug of choice during remission-induction chemotherapy in acute myeloid leukaemia, myelodysplastic syndrome and allogeneic haematopoietic stem cell transplantation with graft versus host disease (AI). In the pre-engraftment period of allogeneic transplantation, several antifungals are appropriate and can be recommended with equal strength: voriconazole (BI), micafungin (BI), fluconazole (BI) and posaconazole (BII). There is poor evidence regarding antifungal prophylaxis in the post-engraftment period of allogeneic haematopoietic stem cell transplantation if no steroids for treatment of graft versus host disease are required. Aerosolised liposomal amphotericin B inhalation in conjunction with fluconazole can be used in patients with prolonged neutropenia (BII).
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Affiliation(s)
- Daniela Tacke
- Klinik I für Innere Medizin, Uniklinik Köln, Köln, Germany
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Science M, Robinson PD, MacDonald T, Rassekh SR, Dupuis LL, Sung L. Guideline for primary antifungal prophylaxis for pediatric patients with cancer or hematopoietic stem cell transplant recipients. Pediatr Blood Cancer 2014; 61:393-400. [PMID: 24424789 DOI: 10.1002/pbc.24847] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 10/14/2013] [Indexed: 12/30/2022]
Abstract
This guideline provides clinicians with evidence-based recommendations on the use of antifungal prophylaxis in children with cancer and undergoing hematopoietic stem cell transplantation (HSCT). Recommendations are divided into: (1) allogeneic HSCT (2) autologous HSCT (3) acute myeloid leukemia or myelodysplastic syndrome and (4) patients with malignancy and neutropenia for >7 days. A systematic review was conducted and evidence summaries compiled. The quality of evidence and strength of each recommendation was determined using GRADE. Implementation of these recommendations will require adaptation to local context. The contribution of this guideline in the prevention of invasive fungal infections requires prospective evaluation.
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Affiliation(s)
- Michelle Science
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton Health Sciences, Hamilton, Ontario
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Pagano L, Caira M. The role of primary antifungal prophylaxis in patients with haematological malignancies. Clin Microbiol Infect 2014; 20 Suppl 6:19-26. [PMID: 24372659 DOI: 10.1111/1469-0691.12464] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 11/18/2013] [Accepted: 11/18/2013] [Indexed: 11/30/2022]
Abstract
Invasive fungal infections (IFIs) represent important complications in patients with haematological malignancies. Chemoprevention of IFIs may play an important role in this setting, but in the past decades the majority of antifungal drugs utilized demonstrated poor efficacy, particularly in the prevention of invasive aspergillosis. The new triazoles are very useful antifungal drugs, more suitable for prophylaxis of IFIs than amphotericin B and echinocandins. In this review, the main clinical data about antifungal prophylaxis with fluconazole, itraconazole, voriconazole and posaconazole are analysed. At present, posaconazole appears to be the most efficacious azole in antifungal prophylaxis, particularly in patients with acute myeloid leukaemia.
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Affiliation(s)
- L Pagano
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
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Kikuchi M, Nakasone H, Mitani K, Gotoh M, Kobayashi A, Kurita N, Saito T, Sato K, Kanda Y. Retrospective assessment of secondary prophylaxis for invasive aspergillosis in neutropenic hematology patients and identification of risk factors for relapse of fungal disease. ACTA ACUST UNITED AC 2013; 45:531-6. [DOI: 10.3109/00365548.2013.776173] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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