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    Home > Active Ingredient News > Blood System > Bmc Infect Dis: Systemic Antifungal Strategies in Allogeneic Hematopoietic Stem Cell Recipients: Analysis of a Cross-sectional Observational AFHEM Study

    Bmc Infect Dis: Systemic Antifungal Strategies in Allogeneic Hematopoietic Stem Cell Recipients: Analysis of a Cross-sectional Observational AFHEM Study

    • Last Update: 2022-05-21
    • Source: Internet
    • Author: User
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    Invasive fungal disease (IFD) remains a major complication of allogeneic hematopoietic stem cell transplantation (alloHSCT) and is associated with high mortality in patients undergoing alloHSCT
    .
    Because IFD is mostly life-threatening, early diagnosis and initiation of appropriate antifungal therapy are critical to improving clinical outcomes, and antifungal prophylaxis is increasingly used to treat IFD in patients undergoing alloHSCT

    .

    The literature reported here analyzes a cross-sectional observational AFHEM study to describe the use of antifungal drugs in real-world clinical practice in alloHSCT recipients hospitalized in a French hematology ward
    .
    A total of 147 alloHSCT recipients were recruited; the majority were adults (
    n   = 135; 92%) and had received alloHSCT within the first 6 months of enrollment ( n   = 123; 84%)
    .

    n n

    Overall, 119 (81%) patients received systemic antifungal therapy; of these, 95 (80%) patients received antifungal prophylaxis
    .

    119 (81%) patients received systemic antifungal therapy; of these, 95 (80%) patients received antifungal prophylaxis
    .

    Table 1: Frequency of use of systemic antifungal strategies based on preimplantation data (N = 95)

    Table 1: Frequency of use of systemic antifungal strategies based on preimplantation data (N = 95) Table 1: Frequency of use of systemic antifungal strategies based on preimplantation data (N = 95)

    The proportion of patients receiving systemic antifungal therapy was similar regardless of transplant time, neutropenia, and graft-versus-host disease status
    .
    Among patients receiving systemic antifungal therapy, 83 (70%) received azoles, 22 (18%) echinocandins, and 16 (13%) polyenes

    .
    The most commonly used prophylaxis were fluconazole (given to 44 [46%] patients receiving prophylaxis), posaconazole (
    n   = 16; 17%), amphotericin B preparations ( n   ​​= 11; 12%), and Caspofungin ( n  = 11; 12%)
    .

    n n n

    Regarding empiric therapy, 9 (69%) patients received caspofungin, 2 (15%) received liposomal amphotericin B, and the remaining 2 (15%) received azoles (oral fluconazole or intravenous voriconazole)
    .
    Voriconazole was the most common antifungal drug when curative or pre-emptive therapy was used (
    n   = 8; 73%); the majority of these patients ( n   = 6) received oral voriconazole
    .

    n n

    Table 2: Characteristics of hospitalized patients treated with different systemic antifungal strategies during the 5-day observation period

    Table 2: Characteristics of hospitalized patients treated with different systemic antifungal strategies during the 5-day observation period Table 2: Characteristics of hospitalized patients treated with different systemic antifungal strategies during the 5-day observation period Table 2: Treatment with different systemic antifungal strategies during the 5-day observation period characteristics of hospitalized patients

    Of the 95 patients who received antifungal prophylaxis, 56 (59%) had relapsed or refractory disease and 38 (40%) had neutropenia
    .
    GVHD was present in 27 (28%) patients; of these, 14 (52%) had acute grade III-IV GVHD, 10 (37%) had acute grade I-II GVHD, and 7 (26%) had acute grade I-II GVHD Chronic GVHD

    .
    Nineteen (20%) patients had a history of IFD

    .

    Of the 13 patients treated empirically, 8 (62%) had relapsed or refractory disease and 2 (15%) had a history of IFD
    .
    Neutropenia occurred in nine (69%) patients, all of whom had neutropenia for at least 10 days

    .

    Eleven patients were treated according to a preemptive or curative strategy; the majority ( n   =10; 91%) were in relapsed or refractory disease, and four (36%) had experienced an IFD episode
    .
    Four (36%) patients had neutropenia and six (55%) had GVHD, of which five (83%) had acute grade I-II GVHD

    .

    n

    This study has several limitations
    .
    Although this was a prospective study, its cross-sectional design did not take into account the development of antifungal strategies based on changing clinical conditions
    .
    Due to their observational nature, antifungal strategies (ie, prophylactic, empirical, and pre-emptive or therapeutic strategies) are documented at the discretion of the physician and may not match the current definitions published in existing
    guidelines
    .
    The AFHEM study was conducted a few years ago in 2013, however, little has changed in clinical practice since then; for example, the latest European guidelines for primary antifungal prophylaxis still recognize azoles, especially fluconazole, as primary antifungal prophylaxis in patients
    , which is consistent with the findings of this report
    .
    Finally, these results are limited to patients recruited from French centers that agreed to participate in the study, so they may not be representative of the overall use of antifungal therapy in France

    .

    This study has several limitations
    .
    Although this was a prospective study, its cross-sectional design did not take into account the development of antifungal strategies based on changing clinical conditions
    .
    Due to their observational nature, antifungal strategies (ie, prophylactic, empirical, and pre-emptive or therapeutic strategies) are documented at the discretion of the physician and may not match the current definitions published in existing
    guidelines
    .
    The AFHEM study was conducted a few years ago in 2013, however, little has changed in clinical practice since then; for example, the latest European guidelines for primary antifungal prophylaxis still recognize azoles, especially fluconazole, as Primary antifungal prophylaxis in patients
    Although this was a prospective study, its cross-sectional design did not take into account the development of antifungal strategies based on changing clinical conditions
    .
    Due to their observational nature, antifungal strategies (ie, prophylactic, empirical, and pre-emptive or therapeutic strategies) are documented at the discretion of the physician and may not match the current definitions published in existing
    guidelines
    .
    guidelines , which is consistent with the report's findings
    .
    Finally, these results are limited to patients recruited from French centers that agreed to participate in the study, so they may not be representative of the overall use of antifungal therapy in France

    .

    Overall, this work provides evidence of an antifungal strategy used in alloHSCT recipients hospitalized in a French haematology ward
    .
    Unlike earlier studies, the AFHEM study showed that prophylaxis appears to be the main antifungal strategy used in French alloHSCT recipients
    .

    Unlike earlier studies, the AFHEM study showed that prophylaxis appears to be the main antifungal strategy used in French alloHSCT recipients
    .

     

    Original source:

    Original source:

    Michallet M, El Cheikh J, Herbrecht R, Yakoub-Agha I, Caillot D, Gangneux JP.
    Systemic antifungal strategies in allogeneic hematopoietic stem cell recipients hospitalized in french hematology units: a post-hoc analysis of the cross-sectional observational AFHEM study.
    BMC Infect Dis.
    2022 Apr 9;22(1):352.
    doi: 10.
    1186/s12879-022-07216-6.
    PMID: 35397492; PMCID: PMC8994341.

    Michallet M, El Cheikh J, Herbrecht R, Yakoub-Agha I, Caillot D, Gangneux JP.
    Systemic antifungal strategies in allogeneic hematopoietic stem cell recipients hospitalized in french hematology units: a post-hoc analysis of the cross-sectional observational AFHEM study.
    BMC Infect Dis.
    2022 Apr 9;22(1):352.
    doi: 10.
    1186/s12879-022-07216-6.
    PMID: 35397492; PMCID: PMC8994341.
    Michallet M, El Cheikh J, Herbrecht R, Yakoub-Agha I, Caillot D, Gangneux JP.
    Systemic antifungal strategies in allogeneic hematopoietic stem cell recipients hospitalized in french hematology units: a post-hoc analysis of the cross-sectional observational AFHEM study.
    BMC Infect Dis.
    2022 Apr 9;22(1):352.
    doi: 10.
    1186/s12879-022-07216-6.
    PMID: 35397492; PMCID: PMC8994341.


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