Is antifungal prophylaxis useful in stem cell transplantation during hospitalization?

Ref ID: 18620

Author:

G. Irrera, G. Messina, G. Console, M. Martino, M. Cuzzola,
A. Meliadí², R. Fedele, T. Moscato, E. Massara, P. Iacopino

Author address:

AO Bianchi Melacrino Morelli (Reggio Calabria, IT)

Full conference title:

Annual Meeting of the EBMT, 37th

Abstract:

Introduction: To date anti-fungal systemic prophylaxis is recommended in autologous stem cell transplant (SCT) recipient S221
subset with prolonged neutropenia and mucosal damage and
in allogeneic mieloablative transplant setting. Limited data support the effi cacy of antifungal prophylaxis applied to neutropenic
and/or immunocompromised patients.
Methods: This is a retrospective study of 1007 SCTs performed
in Bone Marrow Unit of Reggio Calabria Hospital between 1992
and 2009 including 809 consecutive patients. We performed
environmental monitoring of air, water, surfaces in room with
HEPA fi lter for better infectious risk management.
Results: The main characteristics of the patients are reported
in Table 1. Systemic prophylaxis was used according to the
guidelines (Table 2). Our therapy scheme was based on administration of fl uconazole in the nineties years, followed by itraconazole. During 2004 year, these treatments were abolished or
substituted with prophylaxis therapy based on non-adsorbable
molecules in transplants with standard infection risk. Secondary prophylaxis was prescribed for high risk patients with fungal infection history, suggestive iconography, positive fungal
biomarkers. In allogeneic SCT cohort only 3 probable aspergillosis infections and 5 proven fungal infections (1 fusarium,
1 mucor and 3 aspergillosis) were diagnosed. (2 haplotipical,
1 singenic, 1 sibiling, 1 MUD and 2 mismatched), resulting in
death in all cases. The infection rate in allogenic SCT setting
was 3.6% with an incidence rate of 1.1 infection per 10000
transplants/year, while no fungal infection was documented in
autologous SCT setting. These results are signifi cantly lower
than published reports. Finally, during the 17 years our transplant unit has never been colonized by moulds.
Conclusions: Based on our experience, we believe that systemic antifungal prophylaxis should not be performed in autologous SCT patients. except in selected cases. In allogenic
SCT the fungal prophylaxis should be tailored to the treatment
adopted for the patient (bone marrow suppression, reduced
intensity, conditioning) and it has not to be administered in
absence of risk factors according to guidelines. The identifi cation of high risk patients is useful to select for systemic
antifungal or secondary prophylaxis reducing over-treatment,
incidence of resistant strains and costs.

Abstract Number: P789

Conference Year: 2011

Link to conference website: NULL

New link: NULL

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