Survey of antifungal prophylaxis and fungal diagnostic tests employed in malignant haematology and haemopoietic stem cell transplantation (HSCT) in Australia and New Zealand

Sebastiaan J M van Hal, Nicole Gilroy, Orla Morrissey, Leon J Worth, Jeffrey Szer, Constantine Tam, S C Chen, Karin A Thursky, Monica Anne Slavin

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Abstract

This article reports the findings of a survey developed to assess the current use of antifungal prophylaxis among haematology and infectious disease clinicians across Australia and New Zealand, and their alignment with existing consensus guidelines for the use of antifungal agents in the haematology/oncology setting (published 2008). Surveyed clinicians largely followed the current recommendations for prophylaxis in the setting of induction chemotherapy for acute myeloid leukaemia, as well as autologous and low-risk allogeneic haemopoietic stem cell transplantation (HSCT). In keeping with guideline recommendations, posaconazole was the agent used by most centres for high-risk allogeneic HSCT. However, its routine continuation for 75-100 days post-transplantation without de-escalation suggested use beyond those indications described in the 2008 guidelines, namely pre-engraftment neutropenia and graft-versus-host disease. Variations in practice were observed in other settings, such as acute lymphoblastic leukaemia and myelodysplastic syndrome, reflecting the general lack of evidence for antifungal prophylaxis in these patient populations and changing perceptions of risk. With regard to the availability of testing in cases of suspected breakthrough IFD, 40 of centres did not have access to investigative bronchoscopy within 48h of referral, and results of Aspergillus galactomannan (GM), fungal polymerase chain reaction and therapeutic drug monitoring (TDM) were not available within 48h in 83 , 90 and 85 of centres respectively. The survey s findings will influence the recommendations provided in the updated 2014 consensus guidelines for the use of antifungal agents in the haematology/oncology setting.
Original languageEnglish
Pages (from-to)1277 - 1282
Number of pages6
JournalInternal Medicine Journal
Volume44
Issue number12b
DOIs
Publication statusPublished - 2014

Cite this

van Hal, Sebastiaan J M ; Gilroy, Nicole ; Morrissey, Orla ; Worth, Leon J ; Szer, Jeffrey ; Tam, Constantine ; Chen, S C ; Thursky, Karin A ; Slavin, Monica Anne. / Survey of antifungal prophylaxis and fungal diagnostic tests employed in malignant haematology and haemopoietic stem cell transplantation (HSCT) in Australia and New Zealand. In: Internal Medicine Journal. 2014 ; Vol. 44, No. 12b. pp. 1277 - 1282.
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Survey of antifungal prophylaxis and fungal diagnostic tests employed in malignant haematology and haemopoietic stem cell transplantation (HSCT) in Australia and New Zealand. / van Hal, Sebastiaan J M; Gilroy, Nicole; Morrissey, Orla; Worth, Leon J; Szer, Jeffrey; Tam, Constantine; Chen, S C; Thursky, Karin A; Slavin, Monica Anne.

In: Internal Medicine Journal, Vol. 44, No. 12b, 2014, p. 1277 - 1282.

Research output: Contribution to journalArticleResearchpeer-review

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AU - van Hal, Sebastiaan J M

AU - Gilroy, Nicole

AU - Morrissey, Orla

AU - Worth, Leon J

AU - Szer, Jeffrey

AU - Tam, Constantine

AU - Chen, S C

AU - Thursky, Karin A

AU - Slavin, Monica Anne

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