state of the art review
Antifungal prophylaxis during treatment for haematological malignancies: are we there yet?
Article first published online: 20 APR 2011
© 2011 Blackwell Publishing Ltd
British Journal of Haematology
Volume 153, Issue 6, pages 681–697, June 2011
How to Cite
Rogers, T. R., Slavin, M. A. and Donnelly, J. P. (2011), Antifungal prophylaxis during treatment for haematological malignancies: are we there yet?. British Journal of Haematology, 153: 681–697. doi: 10.1111/j.1365-2141.2011.08650.x
- Issue published online: 25 MAY 2011
- Article first published online: 20 APR 2011
- antifungal prophylaxis;
- stem cell transplantation;
- invasive fungal disease;
- invasive aspergillosis
Antifungal prophylaxis during treatment for haematological malignancies has been studied for 50 years, yet it has not been wholly effective even when using antifungal drugs that exhibit potent activity in vitro against a broad range of fungal pathogens. Trials have demonstrated that it can reduce the incidence of invasive fungal diseases (IFD) and fungal deaths, but only two studies have had an impact on overall mortality. Furthermore, it has not significantly reduced the need for empirical antifungal therapy. Posaconazole was effective in preventing invasive aspergillosis in two studies of high-risk patients, and consensus guidelines grade it as a suitable choice for antifungal prophylaxis of invasive mould disease; however, its bioavailability was compromised by vomiting or diarrhoea so that an alternative parenteral antifungal drug was required. A recent trial of voriconazole prophylaxis after allogeneic stem cell transplantation failed to show superiority over fluconazole. With more accurate definitions of IFD, that utilize fungal biomarkers, such as galactomannan, together with computerized tomographic imaging, there is growing interest in a diagnostic-driven strategy, which could prove to be a more efficacious approach.