Despite the paramount importance of host defenses in determining the occurrence and outcome of IFI, strategies to enhance these defenses are currently limited. Granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) stimulate recovery of the neutrophil count after nontransplant chemotherapy or pretransplant chemoradiotherapy. However, studies of prophylactic G-CSF or GM-CSF have not convincingly shown any benefit of these agents in the prevention of IFI.94 Nonetheless, in patients with prolonged neutropenia or delayed marrow engraftment, it is reasonable to administer G-CSF or GM-CSF, since persistent neutropenia in these patients is a major risk factor for fungal infection. Granulocyte transfusions, collected from donors pretreated with colony-stimulating factors, have also been used in patients with persistent neutropenia, but their efficacy for preventing fungal infections is unproven. 94 In allogeneic HSCT patients, GVHD and its treatment with immunosuppressive drugs (especially corticosteroids) has become the primary risk factor for IFI. Thus, improved methods for preventing GVHD and reducing the need for greater immunosuppression should be a priority.
Course Number: V035D
This CME Expires on July 1, 2005; no tests will be accepted after this date.
This course is accredited by
The University of Pittsburgh School of Medicine, Center for Continuing Education and The International Immunocompromised Host Society
|
