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Post-Transplant Events

An early CT-diagnosis-based treatment strategy for invasive fungal infection in allogeneic transplant recipients using caspofungin first line: an effective strategy with low mortality

Bone Marrow Transplantation volume 44, pages 51–56 (2009)Cite this article

Abstract

Empirical antifungal therapy is frequently used in allogeneic transplant patients who have persistent febrile neutropenia and can be associated with high cost, toxicity and breakthrough infections. There are limited reports of strategies for early diagnosis of invasive fungal infection (IFI) and, to our knowledge, no reports of treatment strategies based only on high-resolution computerized tomography (HRCT) scans. We used an early treatment strategy for IFI in 99 consecutive patients undergoing allogeneic transplantation. Patients received caspofungin if they had antibiotic-resistant neutropenic fever for more than 72 h and a positive HRCT scan. Fifty-three of 99 patients (54%) had antibiotic-resistant neutropenic fever at 72 h and would have received parenteral antifungal treatment if an empirical approach had been used. The HRCT-based strategy reduced the use of parenteral antifungal agents to 17/99 patients (17%), a 68% reduction. No subsequent diagnoses of IFI occurred within 100 days in patients with a negative HRCT. Only one patient died from IFI within 100 days. These data suggest that this non-empirical strategy may be feasible and that caspofungin may be effective in this setting. A randomized controlled trial is warranted to further assess these results.

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Authors and Affiliations

  1. Section of Haemato-oncology, Royal Marsden Hospital, Sutton, Surrey, UK

    F L Dignan, S O Evans, M E Ethell, B E Shaw, F E Davies, C E Dearden, J G Treleaven, G J Morgan & M N Potter

  2. Anthony Nolan Trust, London, UK

    B E Shaw

  3. Department of Microbiology, Royal Marsden Hospital, Sutton, Surrey, UK

    U B G Riley

Authors
  1. F L Dignan
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  2. S O Evans
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  3. M E Ethell
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  4. B E Shaw
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  7. J G Treleaven
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Correspondence to F L Dignan.

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Dignan, F., Evans, S., Ethell, M. et al. An early CT-diagnosis-based treatment strategy for invasive fungal infection in allogeneic transplant recipients using caspofungin first line: an effective strategy with low mortality. Bone Marrow Transplant 44, 51–56 (2009). https://doi.org/10.1038/bmt.2008.427

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  • DOI: https://doi.org/10.1038/bmt.2008.427

Keywords

  • CT scan
  • fungal infection
  • allogeneic transplant
  • caspofungin

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