Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Post-Transplant Events

European guidelines for antifungal management in leukemia and hematopoietic stem cell transplant recipients: summary of the ECIL 3—2009 Update

Bone Marrow Transplantation volume 46, pages 709–718 (2011)Cite this article

Subjects

Abstract

In 2005, several groups, including the European Group for Blood and Marrow Transplantation, the European Organization for Treatment and Research of Cancer, the European Leukemia Net and the Immunocompromised Host Society created the European Conference on Infections in Leukemia (ECIL). The main goal of ECIL is to elaborate guidelines, or recommendations, for the management of infections in leukemia and stem cell transplant patients. The first sets of ECIL slides about the management of invasive fungal disease were made available on the web in 2006 and the papers were published in 2007. The third meeting of the group (ECIL 3) was held in September 2009 and the group updated its previous recommendations. The goal of this paper is to summarize the new proposals from ECIL 3, based on the results of studies published after the ECIL 2 meeting: (1) the prophylactic recommendations for hematopoietic stem cell transplant recipients were formulated differently, by splitting the neutropenic and the GVHD phases and taking into account recent data on voriconazole; (2) micafungin was introduced as an alternative drug for empirical antifungal therapy; (3) although several studies were published on preemptive antifungal approaches in neutropenic patients, the group decided not to propose any recommendation, as the only randomized study comparing an empirical versus a preemptive approach showed a significant excess of fungal disease in the preemptive group.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

Article Open access 02 April 2022

Georg Maschmeyer, Lars Bullinger, … Thierry Calandra

References

  1. Maertens J, Frere P, Lass-Flörl C, Heinz W, Cornely OA . Primary antifungal prophylaxis in leukaemia patients. Eur J Cancer 2007; Suppl 5: 43–48.

  2. Marchetti O, Cordonnier C, Calandra T . Empirical antifungal therapy in neutropenic cancer patients with persistent fever. Eur J Cancer 2007; Suppl 5: 32–42.

  3. Herbrecht R, Flückiger U, Gachot B, Ribaud P, Tiebaut A, Cordonnier C . Treatment of invasive candida and invasive aspergillus infections in adult haematological patients. Eur J Cancer 2007; Suppl 5: 49–59.

  4. ECIL Guidelines for the management of bacterial, fungal and viral infections 2009. http://www.ichs.org/Ecilslides/ECIL%203%20Empirical%20Antifungal%20Therapy%20Update%202009.pdf.

  5. Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 48: 503–535.

    Article  CAS  PubMed  Google Scholar 

  6. Walsh TJ, Anaissie EJ, Dennin DW, Herbrecht R, Kontoyaiannis DP, Marr K et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 2008; 46: 327–360.

    Article  CAS  PubMed  Google Scholar 

  7. Cordonnier C, Calandra T . The first European Conference on infections in leukaemia: why and how? Eur J Cancer 2007; Suppl 5: 2–4.

  8. Kish MA . Guide to development of practice guidelines. Clin Infect Dis 2001; 32: 851–854.

    Article  CAS  PubMed  Google Scholar 

  9. Goodman JL, Winston DJ, Greenfield RA, Chandrasekar PH, Fox B, Kaizer H et al. A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation. N Engl J Med 1992; 326: 845–851.

    Article  CAS  PubMed  Google Scholar 

  10. Marr KA, Seidel K, Slavin MA, Bowden RA, Schoch HG, Flowers ME et al. Prolonged fluconazole prophylaxis is associated with persistent protection against candidiasis-related death in allogeneic marrow transplant recipients: long-term follow-up of a randomized, placebo-controlled trial. Blood 2000; 96: 2055–2061.

    CAS  PubMed  Google Scholar 

  11. Slavin MA, Osborne B, Adams R, Levenstein MJ, Schoch HG, Feldman AR et al. Efficacy and safety of fluconazole prophylaxis for fungal infections after marrow transplantation—a prospective, randomized double blind study. J Infect Dis 1995; 171: 1545–1552.

    Article  CAS  PubMed  Google Scholar 

  12. Ullmann AJ, Lipton JH, Vesole DH, Chandrasekar P, Langston A, Tarantolo SR et al. Posaconazole or fluconazole for prophylaxis in severe graft-versus-host disease. N Engl J Med 2007; 356: 335–347.

    Article  CAS  PubMed  Google Scholar 

  13. Robenshtok E, Gafter-Gvili A, Goldberg E, Weinberger M, Yeshurun M, Leibovici L et al. Antifungal prophylaxis in cancer patients after chemotherapy or hematopoietic stem-cell transplantation: systematic review and meta-analysis. J Clin Oncol 2007; 25: 34.

    Article  Google Scholar 

  14. Marks DI, Kibbler C, Pagliugi A, Ribaud P, Solano C, Heussel CP et al. Voriconazole vs Itraconazole for primary prophylaxis of invasive fungal infection in allogeneic hematopoietic cell transplant (HCT) recipients. In: 49th Interscience Conference on Antimicrobial Agents and Chemotherapy; 2009; San Francisco, CA 2009.

  15. Wingard JR, Carter SL, Walsh TJ, Kurtzberg J, Small TN, Gersten ID et al. Results of a randomized, double-blind trial of Fluconazole vs Voriconazole for the prevention of invasive fungal infections in 600 allogeneic blood and marrow transplant patients. In: 49th American Society of Hematology Annual Meeting and Exposition; 2007. American Society of Hematology: Atlanta, GA, 2007, p 163.

    Google Scholar 

  16. Rijnders BJ, Cornelissen JJ, Slobbe L, Becker MJ, Doorduijn JK, Hop WC et al. Aerosolized liposomal amphotericin B for the prevention of invasive pulmonary aspergillosis during prolonged neutropenia: a randomized, placebo-controlled trial. Clin Infect Dis 2008; 46: 1401–1408.

    Article  CAS  PubMed  Google Scholar 

  17. Fukuda T, Boeckh M, Guthrie K, Mattson DK, Owens S, Wald A et al. Invasive aspergillosis before allogeneic hematopoetic stem cell transplantation: 10 year experience at a single transplant center. Biol Bone Marrow Transplant 2004; 10: 494–503.

    Article  Google Scholar 

  18. Martino R, Parody R, Fukuda T, Maertens J, Theunissen K, Ho A et al. Impact of the intensity of the pretransplant conditioning regimen in patients with prior invasive aspergillosis undergoing allogeneic hematopoietic stem cell transplantation: a retrospective survey of the infectious diseases working party of the European Group for Blood and Marrow Transplantation. Blood 2006; 108: 2928–2936.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Cordonnier C, Rovira M, Maertens J, Olavarria E, Faucher C, Bilger K et al. Voriconazole for secondary prophylaxis of invasive fungal infection in allogeneic stem cell transplant recipients: results of the VOSIFI study. Hematologica 2010 (in press).

  20. Walsh TJ, Finberg RW, Arndt C, Hiemenz J, Schwartz C, Bodensteiner D et al. Liposomal Amphotericin B for empirical therapy in patients with persistent fever and neutropenia. N Engl J Med 1999; 340: 764–771.

    Article  CAS  PubMed  Google Scholar 

  21. Walsh TJ, Teppler H, Donowitz GR, Maertens J, Baden LR, Dmoszynska A et al. Caspofungin versus liposomal Amphotericin B for empirical antifungal therapy in patients with persistent fever and neutropenia. N Engl J Med 2004; 351: 1391–1402.

    Article  CAS  PubMed  Google Scholar 

  22. Tamura K, Urabe A, Yoshida M, Kanamaru A, Kodera Y, Okamoto S et al. Efficacy and safety of micafungin, an echinocandin antifungal agent, on invasive fungal infections in patients with hematological disorders. Leuk Lymphoma 2009; 50: 92–100.

    Article  CAS  PubMed  Google Scholar 

  23. Kubiak X . Caspofungin vs micafungin for empirical therapy in adult neutropenic patients with persistent fever: a retrospective analysis. In: 48th ICAAC; 2008. Washington, DC, 2008.

    Google Scholar 

  24. Maertens J, Madero-Lopez L, Reilly AF, Lehrnbecher T, Groll AH, Jafri HS ; et al. Caspofungin vs liposomal AmB for empirical therapy in pediatric neutropenic patients with persistent fever: a randomized, double-blind, multicenter trial. Pediatr Infect Dis J 29: 415–420.

  25. Ohta K, Kosaka SN, Nakao Y, Kumura T, Hagihara K, Sakamoto E et al. Efficacy and safety of intravenous itraconazole as empirical antifungal therapy for persistent fever in neutropenic patients with hematological malignancies in Japan. Int J Hematol 2009; 89: 649–655.

    Article  CAS  PubMed  Google Scholar 

  26. Lafaurie M, Lapalu J, Raffoux E, Breton B, Lacroix C, Socié G et al. High rate of breakthrough invasive aspergillosis among patients receiving caspofungin for persistent fever and neutropenia. Clin Microbiol Infect 2009 (e-pub ahead of print 3 September 2009).

  27. Segal BH, Almyroudis NG, Battiwalla M, Herbrecht R, Perfect JR, Walsh TJ et al. Prevention and early treatment of invasive fungal infection in patients with cancer and neutropenia and in stem cell transplant recipients in the era of newer broad-spectrum antifungal agents and diagnostics adjuncts. Clin Infect Dis 2007; 44: 402–409.

    Article  PubMed  Google Scholar 

  28. Maertens J, Theunissen K, Verhoef G, Verschakelen J, Lagrou K, Verbeken E et al. Galactomannan and computed tomography-based preemptive antifungal therapy in neutropenic patients at high risk for invasive fungal infection: a prospective feasibility study. Clin Infect Dis 2005; 41: 1242–1250.

    Article  CAS  PubMed  Google Scholar 

  29. Cordonnier C, Pautas C, Maury S, Vekhoff A, Farhat H, Suarez F et al. Empirical versus pre-emptive antifungal strategy in high-risk febrile neutropenic patients: a prospective randomized study. Clin Infect Dis 2009; 48: 1042–1051.

    Article  CAS  PubMed  Google Scholar 

  30. Hebart H, Klingspor L, Klingebiel T, Loeffler J, Tollemar J, Ljungman P et al. A prospective ranomized controlled trial comparing PCR-based and empirical treatment with liposomal amphotericin B in patients after allogeneic stem cell transplant. Bone Marrow Transplant 2008; 43: 553–561.

    Article  PubMed  Google Scholar 

  31. Riva E, Nosari A, Brizio A, Molteni A, Vanelli C, Gabutti C et al. In high risk acute leukemia patients, early antifungal therapy improves the outcome of invasive mould infections. In: 48th Interscience Conference on Antimicrobial Agents and Chemotherapy; 2008, Chicago, IL 2008.

  32. Aguilar-Guisado M, Espigado I, Cordero E, Noguer N, Parody R, Pachon J et al. Empirical antifungal therapy in selected patients with persistent febrile neutropenia. Bone Marrow Transplant 2010; 45: 159–164.

    Article  CAS  PubMed  Google Scholar 

  33. Barnes RA, White PL, Bygrave C, Evans N, Healy B, Kell J . Clinical impact of enhanced diagnosis of invasive fungal disease in high-risk haematology and stem cell transplant patients. J Clin Pathol 2009; 62: 64–69.

    Article  CAS  PubMed  Google Scholar 

  34. Dignan FL, Evans SO, Ethell ME, Shaw BE, Davies FE, Dearden CE 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 2009; 44: 51–56.

    Article  CAS  PubMed  Google Scholar 

  35. Girmenia C, Micozzi A, Gentile G, Santilli S, Arleo E, Cardarelli L et al. Clinically driven diagnostic antifungal approach in neutropenic patients: a prospective feasibility study. J Clin Oncol 2010; 28: 667–674.

    Article  PubMed  Google Scholar 

  36. Viscoli C, Herbrecht R, Akan H, Baila L, Sonet A, Gallamini A et al. An EORTC Phase II study of caspofungin as first-line therapy of invasive aspergillosis in haematological patients. J Antimicrob Chemother 2009; 64: 1274–1281.

    Article  CAS  PubMed  Google Scholar 

  37. Herbrecht R, Maertens J, Baila L, Aoun M, Heinz W, Martino R et al. Caspofungin first-line therapy for invasive aspergillosis in allogeneic hematopoietic stem cell transplant patients: a European Organisation for Research and Treatment of Cancer study. Bone Marrow Transplant 2010 (e-pub ahead of print 11 January 2010; doi:10.1038/bmt.2009.334).

  38. Hachem RY, Boktour MR, Hanna HA, Husni RN, Torres HA, Aliff C et al. Amphotericin B lipid complex versus liposomal amphotericin B monotherapy for invasive aspergillosis in patients with hematologic malignancy. Cancer 2008; 112: 1282–1287.

    Article  CAS  PubMed  Google Scholar 

  39. Cesaro S, Giacchino M, Locatelli F, Spiller M, Buldini B, Castellini C et al. Safety and efficacy of a caspofungin-based combination therapy for treatment of proven or probable aspergillosis in pediatric hematological patients. BMC Infect Dis 2007; 18: 28.

    Article  Google Scholar 

  40. Betts RF, Nucci M, Talwar D, Gareca M, Queiroz-Telles F, Bedimo RJ et al. A multicenter, double-blind trial of a high-dose caspofungin treatment regimen versus a standard caspofungin treatment regimen for adult patients with invasive candidiasis. Clin Infect Dis 2009; 48: 1676–1684.

    Article  CAS  PubMed  Google Scholar 

  41. Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 2002; 347: 408–415.

    Article  CAS  PubMed  Google Scholar 

  42. Mora-Duarte J, Betts R, Rotstein C, Colombo AL, Thompson-Moya L, Smietana J et al. Comparison of caspofungin and amphotericin B for invasive candidiasis. N Engl J Med 2002; 347: 2020–2029.

    Article  CAS  PubMed  Google Scholar 

  43. Kullberg BJ, Sobel JD, Ruhnke M, Pappas PG, Viscoli C, Rex JH et al. Voriconazole versus a regimen of amphotericin B followed by fluconazole for candidaemia in non-neutropenic patients: a randomised non-inferiority trial. Lancet 2005; 366: 1435–1442.

    Article  CAS  PubMed  Google Scholar 

  44. Reboli AC, Rotstein C, Pappas PG, Chapman SW, Kett DH, Kumar D et al. Anidulafungin versus fluconazole for invasive candidiasis. N Engl J Med 2007; 356: 2472–2482.

    Article  CAS  PubMed  Google Scholar 

  45. Kuse ER, Chetchotisakd P, da Cunha CA, Ruhnke M, Barrios C, Raghunadharao D et al. Micafungin versus liposomal amphotericin B for candidaemia and invasive candidosis: a phase III randomised double-blind trial. Lancet 2007; 369: 1519–1527.

    Article  CAS  PubMed  Google Scholar 

  46. Pappas PG, Rotstein CM, Betts RF, Nucci M, Talwar D, De Waele JJ et al. Micafungin versus caspofungin for treatment of candidemia and other forms of invasive candidiasis. Clin Infect Dis 2007; 45: 883–893.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The ECIL Organization Committee is indebted to the companies that supported the expert meetings through educational grants since ECIL 1 in 2005: Astellas Pharma, Bristol-Myers Squibb, Cephalon, Gilead Sciences, Glaxo-Smith Beecham, MSD, Novartis, Pfizer, Schering-Plough, Wyeth, Zeneus-Pharma and Cephalon. They are thankful to Jean-Michel Gosset and KOBE, Group GL events, Lyon, for the organization of the meetings. They are also indebted to the participants of the ECIL 3 meeting: Murat Akova, Turkey; Maiken Arendrup, Denmark; Rosemary Barnes, UK; Jacques Bille, Switzerland; Stéphane Bretagne, France; Thierry Calandra, Switzerland; Elio Castagnola, Italy; Catherine Cordonnier, France; Oliver A Cornely, Germany; Mario Cruciani, Italy; Manuel Cuenca-Estrella, Spain; Eric Dannaoui, France; Rafael De La Camara, Spain; Emma Dellow (Gilead Sciences), UK; Peter Donnelly, The Netherlands; Lubos Drgona, Slovakia; Hermann Einsele, Germany; Dan Engelhard, Israel; Ursula Flückiger, Switzerland; Bertrand Gachot, France; Jesus Gonzales-Moreno (MSD), Spain; Andreas Groll, Germany; Ina Hanel (Astellas), Germany; Raoul Herbrecht, France; Claus-Peter Heussel, Germany; Brian Jones, UK; Christopher Kibbler, UK; Nikolai Klimko, Russia; Lena Klingspor, Sweden; Michal Kouba, Czech Republic; Frederic Lamoth, Switzerland; Fanny Lanternier, France; Thomas Lehrnbecher, Germany; Juergen Loeffler, Germany; Olivier Lortholary, France; Johan Maertens, Belgium; Oscar Marchetti, Switzerland; Alexey Maschan, Russia; Malgorzata Mikulska, Italy; Livio Pagano, Italy; Goergios Petrikos, Greece, Daniel Poulain, France; Zdenek Racil, Czech Republic; Pierre Reusser, Switzerland; Patricia Ribaud, France; Malcolm Richardson, UK; Valérie Rizzi-Puechal (Pfizer), France; Markus Ruhnke, Germany; Maurizio Sanguinetti, Italy; Janos Sinko, Hungary; Anna Skiada, Greece; Jan Styczynski, Poland; Anne Thiebaut, France; Paul Verweij, The Netherlands; Claudio Viscoli, Italy; Janice Wahl (Schering-Plough) USA; Katherine Ward, UK; and Philipe White, UK.

Author information

Author notes

  1. J Maertens, O Marchetti, R Herbrecht, O A Cornely, U Flückiger, P Frêre, B Gachot, W J Heinz, C Lass-Flörl, P Ribaud, A Thiebaut and C Cordonnier: See Appendix for details.

Authors and Affiliations

  1. Department of Hematology, Leukemia and Stem Cell Transplantation Unit, University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium

    J Maertens

  2. Department of Medicine, Infectious Diseases Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland

    O Marchetti

  3. Oncology and Hematology Department, Hopitaux Universitaires de Strasbourg, Strasbourg, France

    R Herbrecht

  4. Klinik I für Innere Medizin, Uniklinik Köln and ZKS Köln (BMBF 01KN0706), Köln, Germany

    O A Cornely

  5. Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Basel, Switzerland

    U Flückiger

  6. Hematology Department, CHR Verviers, Verviers, Belgium

    P Frêre

  7. Pole Microbiologie et Maladies Infectieuses, Institut Gustave Roussy, Villejuif, France

    B Gachot

  8. Department of Internal Medicine II, University of Würzburg Medical Centre, Würzburg, Germany

    W J Heinz

  9. Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Innsbruck, Austria

    C Lass-Flörl

  10. Stem Cell Transplantation Unit, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris and Université Paris 7, Paris, France

    P Ribaud

  11. Hematology Department, University Hospital, Grenoble, France

    A Thiebaut

  12. Hematology Department, Henri Mondor Teaching Hospital, Assistance Publique-Hôpitaux de Paris and Paris University, Créteil, France

    C Cordonnier

Authors
  1. J Maertens
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. O Marchetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R Herbrecht
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. O A Cornely
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. U Flückiger
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P Frêre
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. B Gachot
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. W J Heinz
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. C Lass-Flörl
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. P Ribaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. A Thiebaut
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. C Cordonnier
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the third European Conference on Infections in Leukemia

Corresponding author

Correspondence to C Cordonnier.

Ethics declarations

Competing interests

JM is a consultant for Astellas Pharma, Gilead Sciences, Merck Sharp & Dohme, Pfizer and Schering-Plough and has received grants from Pfizer, Merck Sharp & Dohme, Cephalon and Gilead. OM received unrestricted research grants from and/or was consultant to Gilead Sciences, Merck, Sharp & Dohme, Pfizer and Schering-Plough. RH has received a grant from Pfizer and has been consultant for Astellas Pharma, Gilead Sciences, Merck Sharp & Dohme, Pfizer and Schering-Plough. OAC received research grants from Astellas, Basilea, Bayer/Schering, Celgene, Genzyme, Gilead, Medac, Menarini, Merck/Schering-Plough, Merck/Serono, Mölnlycke, Novartis, Optimer, and Pfizer, and Quintiles, is a consultant to Astellas, Basilea, Bayer/Schering, F2G, Gilead, Medac, Merck/Schering-Plough, Mölnlycke, Optimer, and Pfizer, and served at the speakers’ bureau of Astellas, Gilead, Merck/Schering-Plough, Pfizer, SpePharm, and United Medical. UF received unrestricted research grants from and/or was consultant to Gilead Sciences, Merck, Sharp & Dohme, Pfizer, and Schering-Plough. BG received travel grants from Pfizer, Gilead Sciences, MSD and Astellas Pharma. WJH received research grants from Astellas, Basilea, Gilead, Merck/Schering-Plough and Pfizer, is a consultant to Novartis, Merck/Schering-Plough and Pfizer, and served at the speakers’ bureau of Astellas, Gilead, Merck/Schering-Plough and Pfizer. CLF received grants from Pfizer and Gilead. She served at the speakers’ bureau of Gilead, Pfizer and MSD. PR has received grants and research supports from Pfizer, and has been a consultant to Pfizer, Schering-Plough, Gilead Sciences and Merck Sharp & Dohme. AT has been a consultant to MSD, Schering-Plough, Gilead and Pfizer. CC has received grants and research supports from Pfizer, Gilead Sciences and Merck Sharp & Dohme, has been a consultant to Pfizer, Schering-Plough, Gilead Sciences, Merck Sharp & Dohme and Astellas-Pharma, and served at the speakers’ bureau of Gilead Sciences, Merck/Schering-Plough and Pfizer. PF declares no conflict of interest.

Appendix

Appendix

The ECIL is a common initiative of the following groups or organizations: the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation, the Infectious Diseases Group of the European Organization for Research and Treatment of Cancer, the European Leukemia Net (EU grant number: LSHC-CT-2004), and the International Immunocompromised Host Society.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maertens, J., Marchetti, O., Herbrecht, R. et al. European guidelines for antifungal management in leukemia and hematopoietic stem cell transplant recipients: summary of the ECIL 3—2009 Update. Bone Marrow Transplant 46, 709–718 (2011). https://doi.org/10.1038/bmt.2010.175

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2010.175

Keywords

This article is cited by

Search

Advanced search

Quick links