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Antifungal prophylaxis in adult stem cell transplantation and haematological malignancy.

Slavin MA, Heath CH, Thursky KA, Morrissey CO, Szer J, Ling LM, Milliken ST, Grigg AP

  • Journal Internal medicine journal

  • Published 20 Oct 2008

  • Volume 38

  • ISSUE 6b

  • Pagination 468-76

  • DOI 10.1111/j.1445-5994.2008.01723.x


Antifungal prophylaxis can be recommended in patients undergoing induction chemotherapy for acute myeloid leukemia and treatment for grade 2 or greater or chronic extensive graft versus host disease. The evidence for prophylaxis is less clear in other clinical settings although certain groups such as patients with prolonged neutropenia after stem cell transplants using bone marrow or cord blood sources and with impaired cell mediated immunity secondary to treatments such as Alemtuzumab are at high risk. The decision to use prophylaxis and which agent to use will be influenced by effectiveness, number needed to treat and the likelihood of toxicity and drug interactions. The availability of rapid diagnostic tests for fungal infection and institutional epidemiology will also influence the need for and choice of prophylaxis. Whilst prophylaxis can be beneficial, it may impede the ability to make a rapid diagnosis of fungal infection by reducing the yield of diagnostic tests and change the epidemiology of fungal infection. As non-culture based diagnostic tests are refined and become more available there may be a shift from prophylaxis to early diagnosis and treatment.