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Current Strategies in Antifungal Therapy for Invasive Aspergillosis in Immunocompromised Patients Following Hematopoietic Stem Cell Transplantation

Nadim G El Chakhtoura, MD, and Zeina A Kanafani, MD

Despite changing epidemiology, with increasing reports of non-Aspergillus invasive mould infections, and advances in therapy, invasive aspergillosis (IA) remains the most commonly encountered invasive fungal infection (IFI) in hematopoietic stem cell transplant (HSCT) recipients, and the leading cause of death in this patient population, with an established higher risk among allogeneic compared with autologous HSCT recipients [1,2]. Upton et al. reported on a cohort of 405 patients diagnosed with probable or proven IA during 1990–2004, observing a reduction in the rate of disseminated IA over time but a considerable mortality rate for the whole time-frame, with 90.9% of patients dying after the diagnosis of IA, one-third (31.6%) directly attributable to IA [3]. Despite these alarming numbers, a tendency toward improved outcomes was observed for patients diagnosed during the period 2002–2004 compared with those diagnosed in the preceding time-frame (1990–2001).

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