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ECIL updates guidelines for antifungal treatments in patients with leukemia, HSCT
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The European Conference on Infections in Leukemia, or ECIL, recently updated treatment guidelines for fungal infections in patients with leukemia and hematopoietic stem cell transplant recipients. Leaders of the conference now strongly recommend the use of echinocandin as a first-line therapy for invasive candidiasis and isavuconazole as another treatment option for invasive aspergillosis.
“An update of the ECIL antifungal treatment recommendations was needed as there were important new data, and also because of necessary changes in the ECIL grading system so as to be in harmony with other ECIL recommendations,” Frederic Tissot, MD, of the University of Lausanne, Switzerland, and colleagues wrote in Haematologica. “Importantly, the posology and indication of antifungal agents reported in the current guidelines do not necessarily reflect those licensed by the European Medicines Agency, but are the result of a consensus-based analysis of available literature within the ECIL group.”
ECIL is a collaboration between the European Organization for Research and Treatment of Cancer, the European Society for Blood and Marrow Transplantation, the European Leukemia Net and the International Immunocompromised Host Society. The organizations meet every 2 years to develop and update evidence-based recommendations for diagnostic interventions and prophylactic, pre-emptive or targeted therapy strategies against infections in patients with hematologic malignancies or hematopoietic stem cell transplantation (HSCT) recipients.
In a recent report, members of ECIL detailed recommendations for invasive candidiasis, aspergillosis and mucormycosis treatments that were discussed at the latest conference, ECIL-6, held in September 2015. The recommendations are based on data that were collected during an extensive search of literature and abstracts presented at major congresses.
A large review of patients involved in seven major trials allowed ECIL members to strongly recommended the use of echinocandin as a first-line therapy for invasive candidiasis, regardless of underlying predisposing factors. This guideline applies to both the hematologic population and the general population, because the data largely represent non-neuropenic patients, according to Tissot and colleagues. Although evidence shows that liposomal amphotericin B also offers “substantial clinical benefit,” its safety profile is “less favorable” and should be considered as an alternative to echinocandins in patients with contraindications to the medication, the researchers wrote. Among other candidiasis treatment recommendations, Tissot and colleagues suggested the rapid removal of central venous catheters in the hematologic and general population because the practice was associated with a lower mortality rate among patients.
“Although the role of catheter removal in the management of candidemia has long been controversial, most recent studies suggest a beneficial effect on outcome,” they wrote. “If the central venous catheter cannot be removed, treatment should include an echinocandin or a lipid formulation of amphotericin B due to their better activity on Candida biofilms.”
Guidelines for invasive aspergillosis now strongly recommend using either voriconazole or isavuconazole as a primary therapy. In a randomized comparative trial, isavuconazole had similar efficacy but a better safety profile compared with voriconazole. ECIL members do not recommend routine use of first-line combination therapy for invasive aspergillosis. The results of a first-line combination study appeared to favor voriconazole plus anidulafungin vs. voriconazole alone; however, there was a lack of evidence strongly supporting its use, the researchers wrote.
Although the meeting also focused on muormycosis, there were no significant updates regarding the management of the disease.
“As only few new data were published since the last ECIL guidelines, no major changes were made to mucormycosis recommendations,” Tissot and colleagues wrote. – by Stephanie Viguers
Disclosure: Infectious Disease News was unable to confirm relevant financial disclosures at the time of publication.
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