Universität zu Köln

Mellinghoff, Sibylle C., Panse, Jens, Alakel, Nael, Behre, Gerhard, Buchheidt, Dieter, Christopeit, Maximilian ORCID: 0000-0003-4627-0412, Hasenkamp, Justin, Kiehl, Michael, Koldehoff, Michael, Krause, Stefan W., Lehners, Nicola, von Lilienfeld-Toal, Marie, Loehnert, Annika Y., Maschmeyer, Georg, Teschner, Daniel ORCID: 0000-0001-7351-8060, Ullmann, Andrew J., Penack, Olaf, Ruhnke, Markus, Mayer, Karin, Ostermann, Helmut, Wolf, Hans-H. and Cornely, Oliver A. (2018). Primary prophylaxis of invasive fungal infections in patients with haematological malignancies: 2017 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology (DGHO). Ann. Hematol., 97 (2). S. 197 - 208. NEW YORK: SPRINGER. ISSN 1432-0584

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Abstract

Immunocompromised patients are at high risk of invasive fungal infections (IFI), in particular those with haematological malignancies undergoing remission-induction chemotherapy for acute myeloid leukaemia (AML) or myelodysplastic syndrome (MDS) and recipients of allogeneic haematopoietic stem cell transplants (HSCT). Despite the development of new treatment options in the past decades, IFI remains a concern due to substantial morbidity and mortality in these patient populations. In addition, the increasing use of new immune modulating drugs in cancer therapy has opened an entirely new spectrum of at risk periods. Since the last edition of antifungal prophylaxis recommendations of the German Society for Haematology and Medical Oncology in 2014, seven clinical trials regarding antifungal prophylaxis in patients with haematological malignancies have been published, comprising 1227 patients. This update assesses the impact of this additional evidence and effective revisions. Our key recommendations are the following: prophylaxis should be performed with posaconazole delayed release tablets during remission induction chemotherapy for AML and MDS (AI). Posaconazole iv can be used when the oral route is contraindicated or not feasible. Intravenous liposomal amphotericin B did not significantly decrease IFI rates in acute lymphoblastic leukaemia (ALL) patients during induction chemotherapy, and there is poor evidence to recommend it for prophylaxis in these patients (CI). Despite substantial risk of IFI, we cannot provide a stronger recommendation for these patients. There is poor evidence regarding voriconazole prophylaxis in patients with neutropenia (CII). Therapeutic drug monitoring TDM should be performed within 2 to 5 days of initiating voriconazole prophylaxis and should be repeated in case of suspicious adverse events or of dose changes of interacting drugs (BIItu). General TDM during posaconazole prophylaxis is not recommended (CIItu), but may be helpful in cases of clinical failure such as breakthrough IFI for verification of compliance or absorption.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Mellinghoff, Sibylle C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Panse, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED Alakel, Nael UNSPECIFIED UNSPECIFIED UNSPECIFIED Behre, Gerhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Buchheidt, Dieter UNSPECIFIED UNSPECIFIED UNSPECIFIED Christopeit, Maximilian UNSPECIFIED orcid.org/0000-0003-4627-0412 UNSPECIFIED Hasenkamp, Justin UNSPECIFIED UNSPECIFIED UNSPECIFIED Kiehl, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Koldehoff, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Krause, Stefan W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Lehners, Nicola UNSPECIFIED UNSPECIFIED UNSPECIFIED von Lilienfeld-Toal, Marie UNSPECIFIED UNSPECIFIED UNSPECIFIED Loehnert, Annika Y. UNSPECIFIED UNSPECIFIED UNSPECIFIED Maschmeyer, Georg UNSPECIFIED UNSPECIFIED UNSPECIFIED Teschner, Daniel UNSPECIFIED orcid.org/0000-0001-7351-8060 UNSPECIFIED Ullmann, Andrew J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Penack, Olaf UNSPECIFIED UNSPECIFIED UNSPECIFIED Ruhnke, Markus UNSPECIFIED UNSPECIFIED UNSPECIFIED Mayer, Karin UNSPECIFIED UNSPECIFIED UNSPECIFIED Ostermann, Helmut UNSPECIFIED UNSPECIFIED UNSPECIFIED Wolf, Hans-H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Cornely, Oliver A. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-196302
DOI:	10.1007/s00277-017-3196-2
Journal or Publication Title:	Ann. Hematol.
Volume:	97
Number:	2
Page Range:	S. 197 - 208
Date:	2018
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1432-0584
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language LIPOSOMAL AMPHOTERICIN-B; HIGH-RISK PATIENTS; ANTIFUNGAL PROPHYLAXIS; ADVERSE EVENTS; SINGLE-CENTER; INDUCTION CHEMOTHERAPY; EUROPEAN CONFEDERATION; CHANGING EPIDEMIOLOGY; ASPERGILLUS-FUMIGATUS; POSACONAZOLE TABLET Multiple languages Hematology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/19630