Infectious complications after hematopoietic stem cell transplantation: current status and future perspectives in Korea

Cho, Sung-Yeon; Lee, Hyeon-Jeong; Lee, Dong-Gun

Bacteria: consider fluoroquinolone a Fungus: consider prophylaxis during neutropenia, consider PCP prophylaxis Virus: during neutropenia or longer depending on risks HSCT, hematopoietic stem cell transplantation; PCP, Pneumocystis jirovecii pneumonia; GVHD, graft-versus-host disease; TNF-α, tumor necrosis factor-α. a Recent data concern the correlation with fluoroquinolone prophylaxis and development of resistance or Clostridium difficile associated diarrhea. IA accounted for 65.9% of IFI, followed by 26.7% of invasive candidiasis. Interestingly, Aspergillus spp. was not the major fungal pathogen in centers in Thailand and Vietnam, probably because galactomannan testing was unavailable. The heterogeneity of diagnostic, prophylactic, and therapeutic approaches for IFI necessitates local epidemiological data [54] . The incidence of IFI is higher in allogeneic than in autologous HSCT, and the established risk factors include chronic GVHD and steroid use [3] . According to a recent multicenter study performed in Korea (RISK study), the cumulative incidence of IFI after transplantation is 15 [47] . Therefore, active anti-mold prophylaxis should be considered in patients with those risk factors. Currently, voriconazole is available in Korea for secondary prophylaxis of IA after HSCT, and po-saconazole for patients on significant immunosuppressive agents for GVHD.