Antifungal prophylaxis in bone marrow transplantation

Abstract

Deep fungal infection in recipients of bone marrow transplants remains a significant cause of morbidity and mortality. Prolonged neutropenia is the major factor predisposing patients to invasive fungal disease. Candida and Aspergillus species remain the two most common pathogens. Prophylaxis against these organisms with the oral polyenes nystatin and amphotericin B has been disappointing. Systemic amphotericin B is too toxic for prophylactic use, yet it remains the mainstay of therapy for suspected or established deep fungal infection. Ketoconazole is contraindicated in patients receiving cyclosporine prophylaxis against graft-vs.-host disease and appears effective only in high doses associated relatively commonly with adverse reactions. This paper reviews results of antifungal prophylaxis and discusses new measures and agents likely to be of value in the prevention of fungal infection in bone marrow transplantation.