Transplant Infectious Disease, Cleveland Clinic, Department of Infectious Disease, Cleveland Clinic Lerner College of Medicine, Desk S-32, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Curr Infect Dis Rep. 2009 May;11(3):223-8. doi: 10.1007/s11908-009-0033-3.
This article discusses newer antifungal agents, recent randomized controlled trials, and the 2008 guidelines for treatment of aspergillosis in reference to hematopoietic stem cell transplantation (HSCT). Strategies such as reduced-intensity conditioning and agents such as infliximab shed new light on aspergillosis risk. The association between Toll-like receptor polymorphisms and aspergillosis is an exciting development. Posaconazole was evaluated in two randomized prophylaxis trials, and a large, randomized trial established voriconazole's therapeutic superiority to amphotericin. However, many questions remain regarding which patients benefit most from prophylaxis; resistance to newer antifungals; and combination, salvage, and immunomodulatory therapies. Current therapies and strategies have improved the outlook of HSCT recipients with invasive aspergillosis. Future directions include increasingly sophisticated risk stratification, clinical testing of combination therapies, and adjunctive immunomodulatory therapies.
本文讨论了新型抗真菌药物、最近的随机对照试验以及 2008 年造血干细胞移植（HSCT）中曲霉菌病治疗指南，重点介绍了降低强度预处理和英夫利昔单抗等策略对曲霉菌病风险的影响。Toll 样受体多态性与曲霉菌病之间的关系是一个令人兴奋的新进展。泊沙康唑在两项随机预防试验中进行了评估，一项大型随机试验确定了伏立康唑在治疗曲霉菌病方面优于两性霉素。然而，在哪些患者最受益于预防治疗、新型抗真菌药物的耐药性以及联合、挽救和免疫调节治疗方面，仍存在许多问题。目前的治疗方法和策略已经改善了侵袭性曲霉菌病 HSCT 受者的预后。未来的方向包括越来越复杂的风险分层、联合治疗的临床检测以及辅助免疫调节治疗。
