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2016 ; 8
(1
): e2016039
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Antifungal Therapy in Hematopoietic Stem Cell Transplant Recipients
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Mediterr J Hematol Infect Dis
2016[]; 8
(1
): e2016039
PMID27648202
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Invasive fungal infections (IFI) represent a major hindrance to the success of
hematopoietic stem cell transplantation (HSCT), contributing substantially to
morbidity and infection-related mortality. During the most recent years several
reports indicate an overall increase of IFI among hematologic patients, in
particular, invasive aspergillosis, that may be explained, at least partially, by
the fact that diagnoses only suspected in the past, are now more easily
established due to the application of serum biomarkers and early use of CT scan.
Along with new diagnostic options, comes the recent development of novel
antifungal agents that expanded the spectrum of activity over traditional
treatments contributing to the successful management of fungal diseases. When
introduced in 1959, Amphotericin B deoxycholate (d-AmB) was a life-saving drug,
and the clinical experience over 50 years has proven that this compound is
effective although toxic. Given the superior safety profile, lipid formulations
of AmB have now replaced d-AmB in many circumstances. Similarly, echinocandins
have been investigated as initial therapy for IA in several clinical trials
including HSCT recipients, although the results were moderately disappointing
leading to a lower grade of recommendation in the majority of published
guidelines. Azoles represent the backbone of therapy for treating
immunocompromised patients with IFI, including voriconazole and the newcomer
isavuconazole; in addition, large studies support the use of mold-active azoles,
namely voriconazole and posaconazole, as antifungal prophylaxis in HSCT
recipients. The aim of the present review is to summarize the clinical
application of antifungal agents most commonly employed in the treatment of IFI.