Prophylaxis or treatment in coping with invasive fungal infections; EBMT meeting

Over 5,000 physicians and nurses specializing in hematopoietic stem cell transplantation (HSCT) met in Hamburg, Germany, at the 32nd annual meeting of the European Group for Blood and Marrow Transplantation, to hear international experts discuss major issues affecting the day-to-day care of their patients. Invasive fungal infections (IFIs), which are among the leading causes of transplant-related mortality, occur most often in the setting of prolonged neutropenia or graft versus host disease (GVHD).

The outcome for patients is better when treatment is started before infection is well established and much discussion at the meeting centered on whether to treat high-risk patients to prevent infections before they develop symptoms (ie, prophylaxis), when they develop markers of occult infections (so-called pre-emptive therapy), or only when they develop early clinical signs and symptoms (so-called empiric therapy). These discussions included strategies on how to identify the patients who would most benefit from prophylactic therapy.

Details of two large trials that studied the prophylactic use of the broad-spectrum triazole posaconazole (Noxafil oral suspension, Schering-Plough) were also discussed at the EBMT meeting. These showed that posaconazole could reduce the incidence of IFIs as well as cut the overall mortality in high-risk patients. These promising results have highlighted the need for continued development of consensus recommendations, such as those discussed at the 1st European Conference on Infection in Leukaemia meeting in September 2005. Current consensus guidelines (which are country specific) state that none of the antifungal agents then available could be recommended for use to prevent both yeast and mould infections in high-risk patients with acute leukemia or those receiving stem cell transplants.