Haematological Malignancies
Eleven of the 17 patients who received caspofungin responded to treatment, and 10 of these were alive at 100 days. Of the six patients who required second-line treatment, four patients responded and four were alive at 100 days.
Craddock stressed the need for a reliable HRCT service for the pre-emptive approach to be successful, with scans performed very early and same-day reporting available.
Conclusions
The faculty concluded that important advances are being made in the understanding, prevention and management of IFD in HSCT patients. However, progress is still needed to establish how best to apply evidence from clinical trials into routine practice, given the
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variations in clinical, therapeutic, environmental and financial factors that apply at different centres. It is clear that once IFD is established the results of treatment are far from optimal, but that antifungal prophylaxis, especially with mould-active agents, can reduce IFD and, with some drugs, affect mortality.
Future developments in non-culture-based diagnostic methods will inform the relative roles of prophylactic, pre-emptive and empirical therapies, but the limited availability and uncertain reliability of some of these methods is restricting their current usage. Wider implementation of new approaches will require good communication within a multidisciplinary team, including haematologists, radiologists, pathologists and chest physicians, to ensure optimal patient care. n
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