BOF: Malignant (Supportive Care)

According to recent guidelines , which ONE of the following patients should not receive antifungal prophylaxis?

a) 18 year old woman undergoing intensive chemotherapy for acute lymphoblastic leukaemia.

b) 22 year old woman commencing antithymocyte globulin and cyclosporine therapy as first definitive treatment for acquired aplastic anaemia.

c) 28 year old man being treated with methylprednisolone and cyclosporine for acute skin graft versus host disease following ablative conditioning allogeneic peripheral blood stem cell transplant as consolidation of remission of poor risk acute myeloid leukaemia.

d) 42 year old man undergoing myeloablative chemotherapy with autologous peripheral blood stem cell rescue as consolidation of remission of stage IV mantle cell lymphoma.

e) 62 year old woman undergoing reduced intensity conditioning allogeneic peripheral blood stem cell transplantation for multiply relapsed follicular lymphoma.

Answer:

42 year old man undergoing myeloablative chemotherapy with autologous peripheral blood stem cell rescue as consolidation of remission of stage IV mantle cell lymphoma.

Explanation:

While local guidelines may differ, the latest international guidelines generally advise against antifungal prophylactic therapy in patients undergoing autologous stem cell transplant with relatively low risk of invasive fungal infection (1-4% incidence) compared to patients receiving allogeneic transplant (5-25% incidence), or intensive or immunosuppressive therapy for aplastic anaemia or acute leukaemia, unless there are specific risks such as a prior invasive fungal infection or pre-existing prologned neutropenia of >7-14 days.

Reference:

Freifeld AG, Bow EJ, Sepkowitz KA et al; Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of America. Infectious Diseases Society of America, Clin Infect Dis. 2011;52(4):e56.