Division of Haematology, Oncology and Palliative Care, Department of Internal Medicine, Evangelisches Klinikum Bethel, Bielefeld, Germany.
Department I of Internal Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany.
Mycoses. 2020 Jul;63(7):653-682. doi: 10.1111/myc.13082. Epub 2020 May 12.
Invasive fungal diseases remain a major cause of morbidity and mortality in cancer patients undergoing intensive cytotoxic therapy. The choice of the most appropriate antifungal treatment (AFT) depends on the fungal species suspected or identified, the patient's risk factors (eg length and depth of granulocytopenia) and the expected side effects.
Since the last edition of recommendations for 'Treatment of invasive fungal infections in cancer patients' of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) in 2013, treatment strategies were gradually moving away from solely empirical therapy of presumed or possible invasive fungal diseases (IFDs) towards pre-emptive therapy of probable IFD.
The guideline was prepared by German clinical experts for infections in cancer patients in a stepwise consensus process. MEDLINE was systematically searched for English-language publications from January 1975 up to September 2019 using the key terms such as 'invasive fungal infection' and/or 'invasive fungal disease' and at least one of the following: antifungal agents, cancer, haematological malignancy, antifungal therapy, neutropenia, granulocytopenia, mycoses, aspergillosis, candidosis and mucormycosis.
AFT of IFDs in cancer patients may include not only antifungal agents but also non-pharmacologic treatment. In addition, the armamentarium of antifungals for treatment of IFDs has been broadened (eg licensing of isavuconazole). Additional antifungals are currently under investigation or in clinical trials.
Here, updated recommendations for the treatment of proven or probable IFDs are given. All recommendations including the levels of evidence are summarised in tables to give the reader rapid access to key information.
侵袭性真菌病仍然是接受强化细胞毒性治疗的癌症患者发病率和死亡率的主要原因。最适当的抗真菌治疗（AFT）的选择取决于怀疑或确定的真菌种类、患者的危险因素（例如，粒细胞减少症的持续时间和深度）以及预期的副作用。
自德国血液学和肿瘤学学会（DGHO）传染病工作组（AGIHO）2013 年发布的最后一版“癌症患者侵袭性真菌感染治疗”建议以来，治疗策略逐渐从推定或可能的侵袭性真菌感染（IFD）的经验性治疗转向可能 IFD 的抢先治疗。
该指南由德国临床专家为癌症患者感染制定，采用逐步共识的方法。使用“侵袭性真菌感染”和/或“侵袭性真菌病”等关键词，以及至少以下之一，在 MEDLINE 上系统地搜索了 1975 年 1 月至 2019 年 9 月的英文文献：抗真菌剂、癌症、血液恶性肿瘤、抗真菌治疗、中性粒细胞减少症、粒细胞减少症、真菌病、曲霉菌病、念珠菌病和毛霉菌病。
癌症患者 IFD 的 AFT 不仅包括抗真菌剂，还包括非药物治疗。此外，治疗 IFD 的抗真菌药物的武器库也得到了扩展（例如伊曲康唑的许可）。目前正在研究或临床试验中的其他抗真菌药物。
本文提供了已证实或可能 IFD 的治疗更新建议。所有建议，包括证据水平，均汇总在表格中，以便读者快速获取关键信息。
