Is antifungal prophylaxis useful in stem cell transplantation during hospitalization?

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)

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.
2011

abstract No: 

P789

Full conference title: 

Annual Meeting of the EBMT, 37th
    • EBMT 37th (2011)