Prophylaxis for aspergillosis in patients with haematological malignancies: pros and cons

ABSTRACT

Introduction: Along with new diagnostic options, comes the recent development of novel antifungal agents that expanded the spectrum of activity over traditional treatments contributing to the successful management of fungal diseases. Nevertheless, invasive fungal infections (IFI) represent a major hindrance to the favorable outcome of patients with hematologic malignancies. According to these observations, an appropriate prevention of IFI occurring in hematologic patients should be considered of paramount importance. However, the wide use of antifungal agents may facilitate the emergence of resistance and may be associated to the occurrence of severe adverse events and eventually may significantly increase the cost of therapeutic procedures.

Areas covered: The aim of present review is to analyze advantages and disadvantages of primary antifungal prophylaxis (PAP) in hematologic patients.

Expert commentary: Patients with AML/MDS undergoing intensive chemotherapy and patients receiving stem cell transplantation are at high risk of IFI, and therefore may benefit form PAP, although several additional factors should be carefully evaluated in our decision-making approach, including the local epidemiology and the prompt availability of diagnostic facilities. The advent of new treatment options for hematologic patients such as target therapies might facilitate the rise of new risk categories so far underestimated.

KEYWORDS:

• Antifungal prophylaxis
• mold-active agents
• polyenes
• echinocandins
• drug-drug interactions

Declaration of interest

A Busca has received honoraria from Gilead Sciences, Merck, Pfizer Pharmaceuticals, and Jazz Pharmaceuticals; he has been a speaker for Gilead Sciences, Merck, Pfizer Pharmaceuticals, Astellas Pharma, and Basilea; he is part of an Advisory Board of GILEAD. L Pagano has received honoraria from Gilead Sciences, Jannsen, Merck, Pfizer, Jazz Pharmaceuticals and Basilea; he has been speaker for Gilead Sciences, Merck, Pfizer, Astellas pharma, and Basilea. He is also part of an advisory board for Gilead, MSD and Novartis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

The manuscript was not funded.