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- Title
From Empirical Toward Preemptive Antifungal Therapy for Patients With Hematological Malignancies and Hematopoietic Stem Cell Transplant Recipients.
- Authors
Ohta, Kensuke
- Abstract
Invasive fungal diseases (IFDs) are a leading cause of morbidity and mortality among patients with hematologic malignancies who received intensive chemotherapies or hematopoietic stem cell transplantation. Whereas a mortality of documented IFDs remains still high in these patients even with recent new antifungal drugs, early start of antifungal therapy has been hampered by a difficulty in an early diagnosis of IFDs. An empirical antifungal treatment, triggered by a presence of neutropenic fever resistant to antibacterial treatments, has long been a standard of care for the high-risk patients. However, since a majority of such neutropenic fevers are not actually caused by true fungal infections, the empirical approach is inevitably accompanied by unnecessary treatments that are responsible for unnecessary costs and toxicity, and also for difficulty in the statistical evaluation of its clinical benefits. In recent, in order to more effectively target the patients who may benefit from antifungal therapy, various "preemptive" approaches have been proposed in which antifungal therapy was reserved until additional findings suggestive of IFDs were obtained from nonculture-based blood tests and/or radiological approaches. Although the only randomized comparative study of these studies failed to demonstrate a satisfactory safety of the preemptive approach, a series of other single-arm studies have provided a number of strong suggestions for improving the strategy. Future prospective comparative studies based on these findings are expected to establish a safe replacement of empirical therapy with preemptive approaches.
- Publication
European Journal of Clinical & Medical Oncology, 2012, Vol 4, Issue 2, p83
- ISSN
1759-8958
- Publication type
Academic Journal