PROGRESS IN FIGHTING SYSTEMIC FUNGAL-INFECTIONS IN HEMATOLOGICAL NEOPLASIA

Considering the limited data available, there is clearly a need for th orough, well-designed clinical research on the epidemiology, diagnosis , treatment and prevention of invasive fungal infection in patients wh o are treated for cancer. Our knowledge has increased, but the informa tion obtained so far is patchy and not generally applicable, as it is influenced by local problems and circumstances. New diagnostic tools h ave become available, but they are still insufficient in many cases. U ntil the value of the presently available chemoprophylaxis has been es tablished beyond doubt, the strategy should be one of wait-and-see for patients with a low or moderate risk of developing infection. In bone marrow transplant recipients fluconazole has shown favourable results in eliminating yeast infections, but in patients at high risk of moul d infections early initiation of intravenous treatment with amphoteric in B at a therapeutic dose remains the best approach. The question of the optimal time point to start empirical antifungal treatment remains and has even been extended by the dispute about what antifungal drugs should be used for this purpose. Amphotericin B is still the drug of choice for the treatment of disseminated fungal infection, but its lip id formulations seem to offer a safer, though far more expensive, alte rnative. Head-to-head comparisons between the different formulations a re required before a final conclusion on their respective efficacies a nd toxicities can be drawn, and it is questionable whether a higher do se will produce better results. Fluconazole appears very useful agains t the majority of Candida infections, whereas itraconazole is effectiv e against both yeast and moulds, providing that adequate resorption ca n be ensured. The results of the first clinical trial of voriconazole in pulmonary aspergillosis have proved very promising.