Treatment of invasive fungal infections in haematology-oncology patients

Abstract

Immunocompromised patients, those with cancer or haematological malignancies and allogeneic bone marrow/haematopoi-etic stem cell transplant recipients carry a high risk of invasive fungal infection (IFI), which is frequently life threatening. The most common causes of IFIs are Aspergillus and Candida species. Patients who receive long-term corticosteroids or broad-spectrum antimicrobial treatment or total parenteral nutrition; patients with central venous catheters, neutropenia, malignancies, or burns and low-weight premature infants are at highest risk of IFI. Early start of antifungal therapy is mandatory, but clinical findings often do not provide clear evidence of IFI. Antifungal agents preferentially used for systemic therapy of IFIs are amphotericin B preparations, fluconazole, voriconazole, posaconazole, caspofungin, anidulafungin, micafungin, and isavuconazole. Local epidemiological data, current resistance profile against antifungal agents, and their pharmacological and economic aspects together with clinical experience must be considered for clinical management of patients with IFI.