Therapie von Pilzinfektionen in der
Hämatologie und Onkologie
Leitlinien der Arbeitsgemeinschaft Infektionen in der Hämatologie
und Onkologie (AGIHO) der Deutschen Gesellschaft für Hämatologie
und Onkologie (DGHO)Treatment of fungal infections in
haematology and oncology.
Guidelines of the Working Party
on Infections in Haematology and
Oncology (AGIHO) of the German
Society for Haematology and
Oncology (DGHO)A. Böhme1
, M. Ruhnke 2
, M. Karthaus3
, H. Einsele4
, S. Guth 5
, G. Heußel6
, C. P. Heußel7
, C. Junghanss 8
, W. V. Kern9
, T. Kubin10
, O. Sezer 2
, G. Silling11
, T. Südhoff12
, H. Szelényi 13
, A. J. Ullmann6
1Med. Klin. III (Direktor: D. Hoelzer), J. W. Goethe-Universität
Frankfurt
2Abt. Innere Med., Schwerp. Hämatologie/Onkologie
(Direktor: K. Possinger), Charité, Campus Mitte der Humboldt-Universität
zu Berlin
3Med. Klinik II, Ev. Johannes-Krankenhaus (Leiter: M. Karthaus)
Bielefeld
4Med. Klinik u. Poliklinik, Abt. und Lehrstuhl II (Direktor:
L. Kanz), Univ.klinikum Tübingen
5Klinik u. Poliklinik für Herz-, Thorax- und Gefäßchirurgie
(Direktor: H. Oelert), Johannes Gutenberg-Universität Mainz
6III. Med. Klinik u. Poliklinik (Direktor: Ch. Huber), Johannes
Gutenberg-Universität Mainz
7Klinik u. Poliklinik für Radiologie (Direktor: M.
Thelen), Johannes Gutenberg-Universität, Mainz
8Abt. Hämatologie/Onkologie (Direktor: M.
Freund), Univ.klinikum Rostock
9Innere Med. III, (Direktor: H. Döhner), Univ. Ulm
10II. Medizin, Hämatologie/Onkologie/Infektionskrankheiten
(Direktor: J. Th. Fischer), Städt. Klinikum Karlsruhe
11Med. Klinik A, Hämatologie/Onkologie, KMT-Zentrum
(Direktor: W.E. Berdel), Westfälische-Wilhelms-Universität
Münster
12Medizinische Klinik (Direktor: W. Schmiegel) der Ruhr-Universität,
Knappschaftskrankenhaus Bochum
13Med. Klinik III, Schwerpunkt Hämatologie, Onkologie
u. Transfusionsmedizin (Direktor: E. Thiel), Univ.klinikum Benjamin
Franklin Berlin
The Infectious Diseases Working Party of the German Society of Hematology and Oncology presents their guidelines for the treatment of fungal infections in patients with hematological and oncological malignancies. These guidelines are evidence-based considering study results, case reports and expert opinions using the evidence criteria of the Infectious Diseases Society of America (IDSA). They offer actual standards and open questions in the treatment of oropharyngeal and esophageal candidosis, invasive candida infections, cryptococcosis, aspergilloses and mucormycoses. Recommendations for the use and handling of amphotericin B, amphotericin B lipid formulations, azoles and combination therapy are given as well as informations about investigational drugs. Surgical procedures, treatment with hematopoietic growth factors and innovative approaches such as granulocyte transfusion are discussed.
Literatur
1
Ahmad S R, Singer S J, Leissa B G.
Congestive
heart failure associated with itraconazole.
Lancet.
2001;
357
1766-1767
2
Anaissie E, Bodey G P, Kantarjian H. et al .
Fluconazole therapy for chronic disseminated
candidiasis in patients with leukemia and prior AmB therapy.
Am
J Med.
1991;
91
142-150
3
Bernard A, Caillot D, Couaillier J F, Casasnovas O, Guy H, Favre J P.
Surgical management
of invasive pulmonary aspergillosis in neutropenic patients.
Ann
Thorac Surg.
1997;
64
1441-1447
4
Böhme A, Karthaus M, Einsele H. et al .
Diagnostik systemischer Pilzinfektionen
in der Hämatologie. Standardempfehlungen der Arbeitsgemeinschaft
Infektiologie in der Hämatologie und Onkologie der Deutschen
Gesellschaft für Hämatologie und Onkologie.
Dtsch
Med Wochenschr.
1999;
124
24-30
(suppl))
5
Caillot D, Casasnovas O, Bernard A. et al .
Improved management of invasive pulmonary
aspergillosis in neutropenic patients using early thoracic computed
tomographic scan and surgery.
J Clin Oncol.
1997;
15
139-147
6
Caillot D, Durand C, Casasnovas O. et al .
Invasive pulmonary aspergillosis in neutropenic
patients. Analysis of a series of 36 cases: contribution of thoracic
scanners and itraconazole.
Ann Med Interne.
1995;
146
84-90
8
Ellis M, Spence D, de Pauw B. et al .
An EORTC
international multicenter randomized trial (EORTC number 19 923)
comparing two dosages of liposomal AmB for treatment of invasive
aspergillosis.
Clin Infect Dis.
1998;
27
1406-1412
9
Edwards J E
Jr, Bodey G P, Bowden R A. et al .
International Conference for the Development
of a Consensus on the Management and Prevention of Severe Candidal
Infections.
Clin Infect Dis.
1997;
25
43-59
10
Eriksson U, Seifert B, Schaffner A.
Comparison
of effects of AmB deoxycholate infused over 4 or 24 hours: randomized
controlled trial.
Br Med J.
2001;
322
1-6
11
Fätkenheuer G, Buchheidt D, Fuhr H -G. et al .
Venenkatheter-assoziierte Infektionen bei
Patienten in Neutropenie.
Dtsch Med Wochenschr.
2000;
126
89-95
12
Glasmacher A, Hahn C, Leutner C. et al .
Breakthrough invasive fungal infections
in neutropenic patients after prophylaxis with itraconazole.
Mycoses.
1999;
42
443-451
13
Habicht J M, Reichenberger F, Gratwohl A, Zerkowski H R, Tamm M.
Surgical
aspects of resection for suspected invasive pulmonary fungal infection
in neutropenic patients.
Ann Thorac Surg.
1999;
68
321-325
14
Heussel C P, Kauczor H U, Heussel G, Mildenberger P, Dueber C.
Aneurysms
complicating inflammatory diseases in immunocompromised hosts: value
of contrast-enhanced CT.
Eur Radiol.
1997;
7
316-319
15
Hübel K, Dale D C, Engert A, Liles W C.
Current status
of granulocyte (neutrophil) transfusion therapy for infectious diseases.
J
Infect Dis.
2001;
183
321-328
16
Karthaus M, Huebner G, Elser C, Geissler R G, Heil G, Ganser A.
Early detection of chronic
disseminated Candida infection in leukemia patients with febrile
neutropenia: value of computer-assisted serial ultrasound documentation.
Ann
Hematol.
1998;
77
41-45
18
Leenders A CAP, Daenen S, Jansen R LH. et al .
Liposomal AmB compared with AmB deoxycholate
in the treatment of documented and suspected neutropenia-induced
invasive fungal infections.
Br J Haematol.
1998;
103
205-212
19
Leenders A C, Reiss P, Portegies P. et al .
Liposomal AmB (AmBisome) compared with
AmB both followed by oral fluconazole in the treatment of AIDS-associated
cryptococcal meningitis.
AIDS.
1997;
11
1463-1471
20
Link H, Blumenstengel K, Böhme A. et al .
Antimikrobielle
Therapie von ungeklärtem Fieber bei Neutropenie. Standardempfehlungen
der Arbeitsgemeinschaft Infektiologie in der Hämatologie
und und Onkologie der Deutschen Gesellschaft für Hämatologie
und Onkologie.
Dtsch Med Wochenschr.
1999;
124
3-8
(suppl))
21
Maschmeyer G, Beinert T h, Buchheidt D, Einsele H, Holler E.
Diagnostik und
Therapie von Lungeninfiltraten bei febrilen neutropenischen Patienten.
Standardempfehlungen der Arbeitsgemeinschaft Infektiologie in der Hämatologie
und und Onkologie der Deutschen gesellschaft für Hämatologie
und Onkologie.
Dtsch Med Wochenschr.
1999;
124
18-23
(suppI))
22
Munk P L, Vellet A D, Rankin R N, Muller N L, Ahmad D.
Intracavitary
aspergilloma: transthoracic percutaneous injection of amphotericin
gelatin solution.
Radiology.
1993;
188
821-823
23
Musa M O, Al E isa A, Halim M. et al .
The spectrum of Fusarium infection in immunocompromised
patients with haematological malignancies and in non-immunocompromised
patients: a single institution experience over 10 years.
Brit
J Haematol.
2000;
108
544-548
26
Oldfield E C, Garst P D, Hostettler C, White M, Samuelson D.
Randomized,
double-blind trial of 1- versus 4-hour AmB infusion durations.
Antimicrob
Agents Chemother.
1990;
34
1402-1406
27
Ozer H, Armitage J O, Bennett L. et al .
2000
update of recommendations for the use of hematopoietic colony-stimulating
factors: Evidence-based, clinical practice guidelines.
J
Clin Oncol.
2000;
18
3558-3585
28
Pagano L, Ricci P, Tonso A. et
al .
Mucormycosis in patients with haematological malignancies:
a retrospective clinical study of 37 cases.
Br J Haematol.
1997;
99
331-336
30
Peters C, Minkov M, Matthes-Martin S. et al .
Leukocyte transfusions from rhG-CSF or
prednisolone stimulated donors for treatment of severe infections
in immunocompromised neutropenic patients.
Br J Haematol.
1999;
106
689-696
31
Phillips P. et al .
A double-blind comparison of itraconazole
oral solution and fluconazole capsules for the treatment of oropharyngeal
candidiasis in patients with AIDS.
Clin Infect Dis.
1998;
26
1368-1373
32
Price T H, Bowden R A, Boeckh M. et al .
Phase I/II trial of neutrophil
transfusions from donors stimulated with G-CSF and dexamethasone
for treatment of patients with infections in hematopoietic stem
cell transplantation.
Blood.
2000;
95
3302-3309
33
Rex J H, Bennett J E, Sugar A M. et al. Candidemia Study Group and the National Institute .
A
randomized trial comparing fluconazole with AmB for the treatment
of candidemia in patients without neutropenia.
N Engl
J Med.
1994;
331
1325-1330
36
Salerno C T, Ouyang D W, Pederson T S. et al .
Surgical therapy for pulmonary aspergillosis
in immunocompromised patients.
Ann Thorac Surg.
1998;
65
1415-1419
41
Stevens D A, Lee J Y.
Analysis of compassionate
use itraconazole therapy for invasive aspergillosis by the NIAID
Mycoses Study Group Criteria.
Arch Intern Med.
1997;
157
1857-1862
42
Tedder M, Spratt J A, Anstadt M P, Hedge S S, Tedder S D, Lowe J E.
Pulmonary mucormycosis:
results of medical and surgical therapy.
Ann Thorac Surg.
1994;
57
1044-1050
43
Van der Horst C M, Saag M S, Cloud G A. et al .
Treatment of cryptococcal meningitis associated
with the acquired immunodeficiency syndrome. National Institute
of Allergy and Infectious Diseases Mycoses Study Group and AIDS
Clinical Trials Group.
N Engl J Med.
1997;
337
15-21
44
Verweij P E, Donnelly J P, Kullberg B J, Meis J F, Pauw G M.
AmB
versus AmB plus flucytosine: poor results in the treatment of proven
systemic mysoses in neutropenic patients.
Infection.
1994;
22
81-85
48
Wilcox C M, Darouiche R O, Laine L, Moskovitz B L, Mallegol I, Wu J.
A randomized, double-blind
comparison of itraconazole oral solution and fluconazole tablets
in the treatment of esophageal candidiasis.
J Infect Dis.
1997;
176
227-232
49
Einsele H, Bertz H, Beyer J, Kiehl M G, Runde V, Kolb HJ, Holler E, Beck R, Schwerdfeger R, Schumacher U, Hebart H, Martin H, Kienast J, Ullmann A J, Maschmeyer G, Krüger W, Link H, Schmidt C A, Oettle H, Klingebiel T. für die Arbeitsgemeinschaft
Infektionen der Deutschen Gesellschaft für Hämatologie
und Onkologie .
Epidemiologie und interventionelle Therapiestrategien infektiöser
Komplikationen nach allogener Stammzelltransplantation.
Dtsch
Med Wochenschr.
2001;
126
1278-1284