Treatment of invasive fungal diseases in cancer patients-Revised 2019 Recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO).

Agranulocytosis / complications Antifungal Agents / therapeutic use Hematologic Neoplasms / complications Hematology / methods Humans Immunocompromised Host Invasive Fungal Infections / drug therapy Neoplasms / complications Practice Guidelines as Topic
antifungal agents aspergillosis candidosis- mucormycosis haematologic malignancies-cancer-IFD invasive fungal disease mycoses therapy

Journal

Mycoses
ISSN: 1439-0507
Titre abrégé: Mycoses
Pays: Germany
ID NLM: 8805008

Informations de publication

Date de publication:
Jul 2020
Historique:
received: 20 02 2020
revised: 05 03 2020
accepted: 10 03 2020
pubmed: 3 4 2020
medline: 7 2 2021
entrez: 3 4 2020
Statut: ppublish

Résumé

Invasive fungal diseases remain a major cause of morbidity and mortality in cancer patients undergoing intensive cytotoxic therapy. The choice of the most appropriate antifungal treatment (AFT) depends on the fungal species suspected or identified, the patient's risk factors (eg length and depth of granulocytopenia) and the expected side effects. Since the last edition of recommendations for 'Treatment of invasive fungal infections in cancer patients' of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) in 2013, treatment strategies were gradually moving away from solely empirical therapy of presumed or possible invasive fungal diseases (IFDs) towards pre-emptive therapy of probable IFD. The guideline was prepared by German clinical experts for infections in cancer patients in a stepwise consensus process. MEDLINE was systematically searched for English-language publications from January 1975 up to September 2019 using the key terms such as 'invasive fungal infection' and/or 'invasive fungal disease' and at least one of the following: antifungal agents, cancer, haematological malignancy, antifungal therapy, neutropenia, granulocytopenia, mycoses, aspergillosis, candidosis and mucormycosis. AFT of IFDs in cancer patients may include not only antifungal agents but also non-pharmacologic treatment. In addition, the armamentarium of antifungals for treatment of IFDs has been broadened (eg licensing of isavuconazole). Additional antifungals are currently under investigation or in clinical trials. Here, updated recommendations for the treatment of proven or probable IFDs are given. All recommendations including the levels of evidence are summarised in tables to give the reader rapid access to key information.

Sections du résumé

BACKGROUND BACKGROUND
Invasive fungal diseases remain a major cause of morbidity and mortality in cancer patients undergoing intensive cytotoxic therapy. The choice of the most appropriate antifungal treatment (AFT) depends on the fungal species suspected or identified, the patient's risk factors (eg length and depth of granulocytopenia) and the expected side effects.
OBJECTIVES OBJECTIVE
Since the last edition of recommendations for 'Treatment of invasive fungal infections in cancer patients' of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) in 2013, treatment strategies were gradually moving away from solely empirical therapy of presumed or possible invasive fungal diseases (IFDs) towards pre-emptive therapy of probable IFD.
METHODS METHODS
The guideline was prepared by German clinical experts for infections in cancer patients in a stepwise consensus process. MEDLINE was systematically searched for English-language publications from January 1975 up to September 2019 using the key terms such as 'invasive fungal infection' and/or 'invasive fungal disease' and at least one of the following: antifungal agents, cancer, haematological malignancy, antifungal therapy, neutropenia, granulocytopenia, mycoses, aspergillosis, candidosis and mucormycosis.
RESULTS RESULTS
AFT of IFDs in cancer patients may include not only antifungal agents but also non-pharmacologic treatment. In addition, the armamentarium of antifungals for treatment of IFDs has been broadened (eg licensing of isavuconazole). Additional antifungals are currently under investigation or in clinical trials.
CONCLUSIONS CONCLUSIONS
Here, updated recommendations for the treatment of proven or probable IFDs are given. All recommendations including the levels of evidence are summarised in tables to give the reader rapid access to key information.

Identifiants

DOI: 10.1111/myc.13082 PMID: 32236989
pubmed: 32236989
doi: 10.1111/myc.13082
doi:

Substances chimiques

Antifungal Agents 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

653-682

Informations de copyright

© 2020 The Authors. Mycoses published by Blackwell Verlag GmbH.

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Auteurs

Markus Ruhnke (M)

Division of Haematology, Oncology and Palliative Care, Department of Internal Medicine, Evangelisches Klinikum Bethel, Bielefeld, Germany.
ORCID: 0000-0002-0793-9729

Oliver A Cornely (OA)

Department I of Internal Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany.
ECMM Excellence Centre of Medical Mycology, Cologne, Germany.
Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.
Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.
ORCID: 0000-0001-9599-3137

Martin Schmidt-Hieber (M)

Klinik für Hämatologie und Onkologie, Carl-Thiem Klinikum, Cottbus, Germany.

Nael Alakel (N)

Department I of Internal Medicine, Haematology and Oncology, University Hospital Dresden, Dresden, Germany.

Boris Boell (B)

Department I of Internal Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany.

Dieter Buchheidt (D)

Department of Hematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany.

Maximilian Christopeit (M)

Department of Stem Cell Transplantation & Oncology, University Medical Center Eppendorf, Hamburg, Germany.

Justin Hasenkamp (J)

Clinic for Haematology and Medical Oncology with Department for Stem Cell Transplantation, University Medicine Göttingen, Göttingen, Germany.

Werner J Heinz (WJ)

Schwerpunkt Infektiologie, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany.
ORCID: 0000-0002-7833-9202

Marcus Hentrich (M)

Hämatologie und Internistische Onkologie, Innere Medizin III, Rotkreuzklinikum München, München, Germany.

Meinolf Karthaus (M)

Department of Haematology & Oncology, Municipal Hospital Neuperlach, München, Germany.

Michael Koldehoff (M)

Klinik für Knochenmarktransplantation, Westdeutsches Tumorzentrum Essen, Universitätsklinikum Essen (AöR), Essen, Germany.

Georg Maschmeyer (G)

Department of Hematology, Onclogy and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany.

Jens Panse (J)

Klinik für Onkologie, Hämatologie und Stammzelltransplantation, Universitätsklinikum Aachen, Aachen, Germany.

Olaf Penack (O)

Division of Haematology & Oncology, Department of Internal Medicine, Charité University Medicine, Campus Rudolf Virchow, Berlin, Germany.

Jan Schleicher (J)

Klinik für Hämatologie Onkologie und Palliativmedizin, Katharinenhospital, Stuttgart, Germany.

Daniel Teschner (D)

III. Medizinische Klinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany.

Andrew John Ullmann (AJ)

Department of Internal Medicine II, Julius Maximilians University, Würzburg, Germany.

Maria Vehreschild (M)

Department I of Internal Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany.
ECMM Excellence Centre of Medical Mycology, Cologne, Germany.
Zentrum für Innere Medizin, Infektiologie, Goethe Universität Frankfurt, Frankfurt am Main, Deutschland.
Deutsches Zentrum für Infektionsforschung (DZIF), Standort Bonn-Köln, Deutschland.

Marie von Lilienfeld-Toal (M)

Klinik für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Germany.

Florian Weissinger (F)

Division of Haematology, Oncology and Palliative Care, Department of Internal Medicine, Evangelisches Klinikum Bethel, Bielefeld, Germany.

Stefan Schwartz (S)

Division of Haematology & Oncology, Department of Internal Medicine, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany.

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Classifications MeSH

questionsmedicales.fr › Hémopathies et maladies lymphatiques › Hémopathies › Troubles leucocytaires › Leucopénie › Agranulocytose › Treatment of invasive fungal diseases in...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antifongiques › Treatment of invasive fungal diseases in...
questionsmedicales.fr › Hémopathies et maladies lymphatiques › Hémopathies › Tumeurs hématologiques › Treatment of invasive fungal diseases in...
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questionsmedicales.fr › Phénomènes du système immunitaire › Sujet immunodéprimé › Treatment of invasive fungal diseases in...
questionsmedicales.fr › Infection › Infections bactériennes et mycoses › Mycoses › Infections fongiques invasives › Treatment of invasive fungal diseases in...
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