TY - JOUR
T1 - How I perform hematopoietic stem cell transplantation on patients with a history of invasive fungal disease
AU - Puerta-Alcalde, Pedro
AU - Champlin, Richard E.
AU - Kontoyiannis, Dimitrios P.
N1 - Funding Information:
This work was supported, in part, by National Institutes of Health, National Cancer Institute CORE support grant 16672 (MD Anderson Cancer Center) and 4R33AI127381. D.P.K. acknowledges the Texas 4000 Distinguished Professorship for Cancer Research. P.P.-A. acknowledges the Rio Hortega grant supported by the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III (CM18/00132).
Publisher Copyright:
© 2020 by The American Society of Hematology.
PY - 2020/12/10
Y1 - 2020/12/10
N2 - Hematopoietic transplantation is the preferred treatment for many patients with hematologic malignancies. Some patients may develop invasive fungal diseases (IFDs) during initial chemotherapy, which need to be considered when assessing patients for transplantation and treatment posttransplantation. Given the associated high risk of relapse and mortality in the post–hematopoietic stem cell transplantation (HSCT) period, IFDs, especially invasive mold diseases, were historically considered a contraindication for HSCT. Over the last 3 decades, advances in antifungal drugs and early diagnosis have improved IFD outcomes, and HSCT in patients with a recent IFD has become increasingly common. However, an organized approach for performing transplantation in patients with a prior IFD is scarce, and decisions are highly individualized. Patient-, malignancy-, transplantation procedure–, antifungal treatment–, and fungus-specific issues affect the risk of IFD relapse. Effective surveillance to detect IFD relapse post-HSCT and careful drug selection for antifungal prophylaxis are of paramount importance. Antifungal drugs have their own toxicities and interact with immunosuppressive drugs such as calcineurin inhibitors. Immune adjunct cytokine or cellular therapy and surgery can be considered in selected cases. In this review, we critically evaluate these factors and provide guidance for the complex decision making involved in the peri-HSCT management of these patients.
AB - Hematopoietic transplantation is the preferred treatment for many patients with hematologic malignancies. Some patients may develop invasive fungal diseases (IFDs) during initial chemotherapy, which need to be considered when assessing patients for transplantation and treatment posttransplantation. Given the associated high risk of relapse and mortality in the post–hematopoietic stem cell transplantation (HSCT) period, IFDs, especially invasive mold diseases, were historically considered a contraindication for HSCT. Over the last 3 decades, advances in antifungal drugs and early diagnosis have improved IFD outcomes, and HSCT in patients with a recent IFD has become increasingly common. However, an organized approach for performing transplantation in patients with a prior IFD is scarce, and decisions are highly individualized. Patient-, malignancy-, transplantation procedure–, antifungal treatment–, and fungus-specific issues affect the risk of IFD relapse. Effective surveillance to detect IFD relapse post-HSCT and careful drug selection for antifungal prophylaxis are of paramount importance. Antifungal drugs have their own toxicities and interact with immunosuppressive drugs such as calcineurin inhibitors. Immune adjunct cytokine or cellular therapy and surgery can be considered in selected cases. In this review, we critically evaluate these factors and provide guidance for the complex decision making involved in the peri-HSCT management of these patients.
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U2 - 10.1182/blood.2020005884
DO - 10.1182/blood.2020005884
M3 - Article
C2 - 33301030
AN - SCOPUS:85098004596
SN - 0006-4971
VL - 136
SP - 2741
EP - 2753
JO - Blood
JF - Blood
IS - 24
ER -