Echinocandin prophylaxis in patients undergoing haematopoietic cell transplantation and other treatments for haematological malignancies Journal Article
| Authors: | Epstein, D. J.; Seo, S. K.; Brown, J. M.; Papanicolaou, G. A. |
| Article Title: | Echinocandin prophylaxis in patients undergoing haematopoietic cell transplantation and other treatments for haematological malignancies |
| Abstract: | Antifungal prophylaxis is the standard of care for patients undergoing intensive chemotherapy for haematological malignancy or haematopoietic cell transplantation (HCT). Prophylaxis with azoles reduces invasive fungal infections and may reduce mortality. However, breakthrough infections still occur, and the use of azoles is sometimes complicated by pharmacokinetic variability, drug interactions, adverse events and other issues. Echinocandins are highly active against Candida species, including some organisms resistant to azoles, and have some clinical activity against Aspergillus species as well. Although currently approved echinocandins require daily intravenous administration, the drugs have a favourable safety profile and more predictable pharmacokinetics than mould-active azoles. Clinical data support the efficacy and safety of echinocandins for antifungal prophylaxis in haematology and HCT patients, though data are less robust than for azoles. Notably, sparse evidence exists supporting the use of echinocandins as antifungal prophylaxis for patients with significant graft-versushost disease (GvHD) after HCT. Two drugs that target (1,3)-β-D-glucan are in development, including an oral glucan synthase inhibitor and an echinocandin with unique pharmacokinetics permitting subcutaneous and weekly administration. Echinocandins are a reasonable alternative to azoles and other agents for antifungal prophylaxis in patients undergoing intensive chemotherapy for haematological malignancy or those receiving HCT, excluding those with significant GvHD. © The Author 2018. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. |
| Keywords: | cancer chemotherapy; treatment outcome; unclassified drug; drug efficacy; drug safety; nonhuman; drug megadose; antineoplastic agent; antifungal agent; hematopoietic stem cell transplantation; drug resistance; acute lymphoblastic leukemia; hematologic malignancy; immunotherapy; drug mechanism; prophylaxis; graft versus host reaction; lymphoproliferative disease; echinocandin; predictive value; pharmacokinetics; myeloid leukemia; systemic mycosis; antifungal therapy; antifungal resistance; human; article; rezafungin; scy 078 |
| Journal Title: | Journal of Antimicrobial Chemotherapy |
| Volume: | 73 |
| Issue: | Suppl. 1 |
| ISSN: | 0305-7453 |
| Publisher: | Oxford University Press |
| Date Published: | 2018-01-01 |
| Start Page: | i60 |
| End Page: | i72 |
| Language: | English |
| DOI: | 10.1093/jac/dkx450 |
| PROVIDER: | scopus |
| PUBMED: | 29304213 |
| PMCID: | PMC7189969 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 February 2018 -- Source: Scopus |
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