Primary antifungal prophylaxis in acute myeloblastic leukemia and myelodysplastic syndrome – still an open question?

Abstract

In this review, we aim to compare different early treatment strategies of invasive fungal diseases in patients undergoing induction chemotherapy for acute myelogenous leukemia or myelodysplastic syndrome. Three treatment approaches – prophylactic, empiric, and pre-emptive treatment – are subject to continuous discussion among physicians treating patients at risk. Considering the available clinical basis of evidence, we opt for antifungal prophylaxis with posaconazole 200 mg tid po as our primary prophylactic strategy, while the employment of pre-emptive treatment should be delayed until more accurate diagnostic tools become available. In addition to antifungal prophylaxis, empiric treatment with caspofungin or L-AmB may be administered to patients with fever resistant to broad-spectrum antibiotic treatment and without radiographic findings typical of invasive fungal disease.

Keywords:

• Myeloid leukemias and dysplasias
• infectious complications
• invasive fungal disease

Acknowledgments

JJV has served at the speakers' bureau of Schering-Plough. MJGTR has served at the speakers' bureau of Schering-Plough. OAC is supported by the German Federal Ministry of Research and Education (BMBF grant 01KN0706) has received research grants from Astellas, Basilea, Bayer, Genzyme, Gilead, Pfizer, Merck, Optimer, Schering-Plough, and Vicuron, has been a consultant to Astellas, Basilea, F2G, Gilead, Pfizer, Merck, Mölnlycke, Nektar, Schering-Plough, and Zeneus, and served at the speakers' bureau of Astellas, Gilead, Merck, Schering-Plough, SpePharm, and United Medical.