A survey of practice relating to the prevention and treatment of invasive fungal infections in UK transplant centres

N. Duncan, C. Craddock, M. Cook on behalf of the UK BMT Pharmacists’ Group

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Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in patients with haematological malignancies. Although guidelines exist for the management of IFIs in this patient group, practice has been shown to vary widely between European haematology centres. The aim of the current study was to investigate whether similar variability exists in the United Kingdom or whether recently published guidelines have helped to standardise practice. A short questionnaire was sent electronically to all members of the UKBMT pharmacists’ group. Questions focused on prophylaxis and treatment of fungal infection in three specifi c clinical areas - AML induction, autologous stem cell transplantation (SCT) and allogeneic SCT. Responses were received from 29 centres. All centres treated autologous SCT and AML patients and 27 treated allogeneic SCT patients. Itraconazole and fl uconazole were the most widely used prophylactic agents although only 72% of centres gave prophylaxis to all three patients groups. Variability existed between patient groups with fl uconazole (dose range 50-400 mg/ day) being most widely used in patients undergoing Autologous SCT (42% of centres) but itraconazole being preferred in the settings of both allogeneic SCT (56%) and AML induction (60%). Four centres (14%) gave posaconazole prophylaxis during AML induction. Empirical therapy was recommended by 22 centres (76%). Ambisome® (dose range 1-3 mg/kg/day) was the most widely used empirical antifungal agent and it was also the fi rst line drug for the management of invasive aspergillosis in 50% of antifungal policies. Voriconazole and caspofungin were recommended as the fi rst line antifungal agent in 23% and 20% of policies respectively. Other fi rst line agents were Abelcet® (7%) and posaconazole (3%). No centres used conventional amphotericin B. Caspofungin was the most popular second line agent, being recommended in 40% of policies, followed by voriconazole (30%) and Ambisome (25%). Twenty centres (69%) would consider giving dual therapy, with combinations of lipid amphotericin plus caspofungin (37%) and lipid amphotericin plus voriconazole (37%) being most commonly recommended. Similar to an earlier Europe-wide survey, this study showed signifi cant variations in practice between UK haematology centres with respect to both preventing and treating invasive fungal infections. Recent guidelines in this area do not appear to have resulted in a standardisation of practice.

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Full conference title: 

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