Abstract：
UNASSIGNED: Invasive fungal diseases (IFD) constitute a major cause of morbidity and mortality in hematopoietic stem cell transplantation (HSCT) recipients.
UNASSIGNED: We describe epidemiology, causes and risk factors of IFD in allogeneic HSCT discussing prophylaxis and treatment in various HSCT phases. We present the most recent studies on this thematic area, including novel data on currently available antifungals, i.e. formulations, dosing, safety, efficacy and therapeutic drug monitoring. Finally, we present the most recent relevant recommendations published. Literature search included PubMed, Scopus, and clinicaltrials.gov between January 2014 and April 2024.
UNASSIGNED: The antifungal agents employed for prophylaxis and therapy should be predicated on local epidemiology of IFD. Fluconazole prophylaxis remains a first-line choice before engraftment when the main pathogen is Candida spp. After engraftment, prophylaxis should be with mold-active agents (i.e. triazoles). For candidiasis, echinocandins are suggested as first-line treatment, whereas aspergillosis responds well to mold-active azoles and liposomal amphotericin B (L-AmB). For mucormycosis, treatment of choice includes L-AmB and isavuconazole. Choice between fever-driven and diagnostics-driven strategies remains equivocal. Open research topics remain: 1) optimization of tools to ensure prompt and accurate IFD diagnosis to avoid unnecessary exposure to antifungals, drug interactions and cost; 2) refinement of treatment for resistant/refractory strains.
UNASSIGNED: We describe epidemiology, causes and risk factors of IFD in allogeneic HSCT discussing prophylaxis and treatment in various HSCT phases. We present the most recent studies on this thematic area, including novel data on currently available antifungals, i.e. formulations, dosing, safety, efficacy and therapeutic drug monitoring. Finally, we present the most recent relevant recommendations published. Literature search included PubMed, Scopus, and clinicaltrials.gov between January 2014 and April 2024.
UNASSIGNED: The antifungal agents employed for prophylaxis and therapy should be predicated on local epidemiology of IFD. Fluconazole prophylaxis remains a first-line choice before engraftment when the main pathogen is Candida spp. After engraftment, prophylaxis should be with mold-active agents (i.e. triazoles). For candidiasis, echinocandins are suggested as first-line treatment, whereas aspergillosis responds well to mold-active azoles and liposomal amphotericin B (L-AmB). For mucormycosis, treatment of choice includes L-AmB and isavuconazole. Choice between fever-driven and diagnostics-driven strategies remains equivocal. Open research topics remain: 1) optimization of tools to ensure prompt and accurate IFD diagnosis to avoid unnecessary exposure to antifungals, drug interactions and cost; 2) refinement of treatment for resistant/refractory strains.
摘要：
■侵袭性真菌病（IFD）是造血干细胞移植（HSCT）受者发病和死亡的主要原因。
■我们描述流行病学，同种异体HSCT中IFD的原因和危险因素讨论了HSCT各个阶段的预防和治疗。我们介绍了关于这一主题领域的最新研究，包括目前可用的抗真菌药物的新数据，即配方，给药,安全,疗效和治疗药物监测。最后,我们提出了最新发表的相关建议。文献检索包括PubMed，Scopus和clinicaltrials.gov在2014年1月至2024年4月之间。
■用于预防和治疗的抗真菌剂应根据IFD的当地流行病学进行预测。当主要病原体是念珠菌属时，氟康唑预防仍然是植入前的一线选择。植入后，应使用霉菌活性剂（即三唑）进行预防。对于念珠菌病，建议将棘白菌素作为一线治疗，而曲霉病对霉菌活性唑类药物和脂质体两性霉素B（L-AmB）反应良好。对于毛霉菌病的治疗选择包括L-AmB和伊沙武康唑。发烧驱动和诊断驱动策略之间的选择仍然模棱两可。开放的研究课题仍然存在：1）优化工具，以确保及时准确的IFD诊断，以避免不必要的抗真菌药物接触，药物相互作用和成本；2)改进耐药/难治性菌株的治疗。
■我们描述流行病学，同种异体HSCT中IFD的原因和危险因素讨论了HSCT各个阶段的预防和治疗。我们介绍了关于这一主题领域的最新研究，包括目前可用的抗真菌药物的新数据，即配方，给药,安全,疗效和治疗药物监测。最后,我们提出了最新发表的相关建议。文献检索包括PubMed，Scopus和clinicaltrials.gov在2014年1月至2024年4月之间。
■用于预防和治疗的抗真菌剂应根据IFD的当地流行病学进行预测。当主要病原体是念珠菌属时，氟康唑预防仍然是植入前的一线选择。植入后，应使用霉菌活性剂（即三唑）进行预防。对于念珠菌病，建议将棘白菌素作为一线治疗，而曲霉病对霉菌活性唑类药物和脂质体两性霉素B（L-AmB）反应良好。对于毛霉菌病的治疗选择包括L-AmB和伊沙武康唑。发烧驱动和诊断驱动策略之间的选择仍然模棱两可。开放的研究课题仍然存在：1）优化工具，以确保及时准确的IFD诊断，以避免不必要的抗真菌药物接触，药物相互作用和成本；2)改进耐药/难治性菌株的治疗。
