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Antifungal prophylaxis in hematopoietic stem cell transplant recipients: the unfinished tale of imperfect success

Bone Marrow Transplantation volume 46, pages 165–173 (2011)Cite this article

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Abstract

Antifungal prophylaxis in hematopoietic stem cell transplant recipients is a rapidly evolving field. For this prophylaxis to be beneficial and cost-effective, the risk of a life-threatening invasive fungal infection (IFI) should outweigh the risks of toxic effects and drug interactions introduced by the antifungal agent used. Not all hematopoietic stem cell transplant recipients have the same risk of IFIs. New prophylactic strategies using risk stratification and new broad-spectrum antifungals have the potential for reducing IFI-associated mortality in these patients. Further refinement of risk stratification and risk/benefit analysis (including pharmacoeconomic analysis) is needed. Stratification of IFI risk could be further sharpened based on emerging genetic and metabolic risk factors. However, 10 years after deciphering the human genome, it is unclear whether the genomic revolution would pay off for identifying the SCT recipients at highest risk for IFIs. Empiricism and reliance on institution-specific epidemiologic data are still expected to be a major part of the ‘art and science’ of risk stratification for fungal infections in SCT.

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Acknowledgements

I thank Russell E. Lewis for useful comments and assistance with figures. This research is supported in part by the National Institutes of Health through MD Anderson's Cancer Center Support Grant CA016672. I dedicate this commentary to my father.

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  1. Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    D P Kontoyiannis

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I received research and grant support and honoraria from Schering-Plough, Pfizer, Astellas Pharma US, Enzon Pharmaceuticals and Merck.

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Kontoyiannis, D. Antifungal prophylaxis in hematopoietic stem cell transplant recipients: the unfinished tale of imperfect success. Bone Marrow Transplant 46, 165–173 (2011). https://doi.org/10.1038/bmt.2010.256

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