Primary prophylaxis of invasive fungal infections in patients with hematologic malignancies. Recommendations of the Infectious Diseases Working Party of the German Society for Haematology and Oncology

被引：139

作者：

Cornely, Oliver A. ^{[1
,2
]}

Boehme, Angelika ^{[3
]}

Buchheidt, Dieter ^{[4
]}

Einsele, Hermann ^{[5
]}

Heinz, Werner J.

Karthaus, Meinolf ^{[6
]}

Krause, Stefan W. ^{[7
]}

Krueger, William ^{[8
]}

Maschmeyer, Georg ^{[9
]}

Penack, Olaf ^{[10
]}

Ritter, Joerg ^{[11
]}

Ruhnke, Markus ^{[12
]}

Sandherr, Michael ^{[13
]}

Sieniawski, Michal ^{[14
]}

Vehreschild, Joerg-Janne

Wolf, Hans-Heinrich ^{[15
]}

Ullmann, Andrew J. ^{[16
]}

机构：

[1] Klinikum Univ Koln, Innere Med Klin 1, Zentrum Klin Studien BMBF 01KN0706, D-50924 Cologne, Germany

[2] Zentrum Klin Studien 01KN0706, Cologne, Germany

[3] Onkol Frankfurt Museumsufer, Frankfurt, Germany

[4] Univ Klinikum Mannheim gGmbH, Med Klin 3, Mannheim, Germany

[5] Univ Klinikum Wurzburg, Med Klin & Poliklin 2, Wurzburg, Germany

[6] Klinikum Neuperlach, Klin Hamatol & Onkol, Munich, Germany

[7] Univ Klinikum Erlangen, Med Klin 5, Erlangen, Germany

[8] Ernst Moritz Arndt Univ Greifswald, Med Klin C, Greifswald, Germany

[9] Klinikum Ernst Von Bergmann, Med Klin Hamatol & Onkol, Potsdam, Germany

[10] Klin Hamatol & Onkol, Charite, Berlin, Germany

[11] Univ Klinikum Munster, Munster, Germany

[12] Charite, Med Klin & Poliklin 2, D-13353 Berlin, Germany

[13] Schwerpunktpraxis Hamatol & Onkol, Weilheim, Germany

[14] Med Sch Newcastle Upon Tyne, Haematol Sci CALS, Newcastle Upon Tyne NE2 4HH, Tyne & Wear, England

[15] Univ Halle Wittenberg, Halle, Germany

[16] Johannes Gutenberg Univ Mainz, Med Klin 3, Mainz, Germany

来源：

HAEMATOLOGICA-THE HEMATOLOGY JOURNAL | 2009年 / 94卷 / 01期

关键词：

invasive fungal infection; antifungal prophylaxis; itraconazole; fluconazole; posaconazole; amphotericin B; liposomal; LIPOSOMAL AMPHOTERICIN-B; BONE-MARROW-TRANSPLANTATION; ITRACONAZOLE ORAL SOLUTION; TRIAL COMPARING ITRACONAZOLE; ACUTE MYELOGENOUS LEUKEMIA; PLACEBO-CONTROLLED TRIAL; ACUTE MYELOID-LEUKEMIA; NEUTROPENIC PATIENTS; DOUBLE-BLIND; ANTIFUNGAL PROPHYLAXIS;

D O I：

10.3324/haematol.11665

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

There is no widely accepted standard for antifungal prophylaxis in patients with hematologic malignancies. The Infectious Diseases Working Party of the German Society for Haematology and Oncology assigned a committee of hematologists and infectious disease specialists to develop recommendations. Literature data bases were systematically searched for clinical trials on antifungal prophylaxis. The studies identified were shared within the committee. Data were extracted by two of the authors (OAC and MSi). The consensus process was conducted by email communication. Finally, a review committee discussed the proposed recommendations. After consensus was established the recommendations were finalized. A total of 86 trials were identified including 16,922 patients. Only a few trials yielded significant differences in efficacy. Fluconazole 400 mg/d improved the incidence rates of invasive fungal infections and attributable mortality in allogeneic stem cell recipients. Posaconazole 600 mg/d reduced the incidence of IFI and attributable mortality in allogeneic stem cell recipients with severe graft versus host disease, and in patients with acute myelogenous leukemia or myelodysplastic syndrome additionally reduced overall mortality. Aerosolized liposomal amphotericin B reduced the incidence rate of invasive pulmonary aspergillosis. Posaconazole 600 mg/d is recommended in patients with acute myelogenous leukemia/myelodysplastic syndrome or undergoing allogeneic stem cell recipients with graft versus host disease for the prevention of invasive fungal infections and attributable mortality (Level A 1). Fluconazole 400 mg/d is recommended in allogeneic stem cell recipients until development of graft versus host disease only (Level A 1). Aerosolized liposomal amphotericin B is recommended during prolonged neutropenia (Level B 11).

引用

页码：113 / 122

页数：10

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