Prophylaxis, diagnosis and therapy of infections in patients undergoing high-dose chemotherapy and autologous haematopoi
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REVIEW ARTICLE
Prophylaxis, diagnosis and therapy of infections in patients undergoing high-dose chemotherapy and autologous haematopoietic stem cell transplantation. 2020 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) Maximilian Christopeit 1 & Martin Schmidt-Hieber 2 & Rosanne Sprute 3,4,5 & Dieter Buchheidt 6 & Marcus Hentrich 7 & Meinolf Karthaus 8 & Olaf Penack 9 & Markus Ruhnke 10 & Florian Weissinger 11 & Oliver A. Cornely 3,4,5,12 & Georg Maschmeyer 13 Received: 6 July 2020 / Accepted: 3 October 2020 # The Author(s) 2020
Abstract To ensure the safety of high-dose chemotherapy and autologous stem cell transplantation (HDC/ASCT), evidence-based recommendations on infectious complications after HDC/ASCT are given. This guideline not only focuses on patients with haematological malignancies but also addresses the specifics of HDC/ASCT patients with solid tumours or autoimmune disorders. In addition to HBV and HCV, HEV screening is nowadays mandatory prior to ASCT. For patients with HBs antigen and/or anti-HBc antibody positivity, HBV nucleic acid testing is strongly recommended for 6 months after HDC/ASCT or for the duration of a respective maintenance therapy. Prevention of VZV reactivation by vaccination is strongly recommended. Cotrimoxazole for the prevention of Pneumocystis jirovecii is supported. Invasive fungal diseases are less frequent after HDC/ ASCT, therefore, primary systemic antifungal prophylaxis is not recommended. Data do not support a benefit of protective room ventilation e.g. HEPA filtration. Thus, AGIHO only supports this technique with marginal strength. Fluoroquinolone prophylaxis is recommended to prevent bacterial infections, although a survival advantage has not been demonstrated. Maximilian Christopeit, Martin Schmidt-Hieber and Rosanne Sprute contributed equally to this work. Oliver A. Cornely and Georg Maschmeyer contributed equally to this work. * Maximilian Christopeit [email protected] 1
Department of Stem Cell Transplantation, University Medical Center Eppendorf, Hamburg, Germany
2
Department of Hematology and Oncology, Carl-Thiem-Klinikum, Cottbus, Cottbus, Germany
3
Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
7
Department of Medicine III—Hematology/Oncology, Red Cross Hospital, Munich, Germany
8
Department of Internal Medicine, Hematology and Oncology, Klinikum Neuperlach, Städtisches Klinikum München, Munich, Germany
9
Department of Internal Medicine, Division of Hematology and Oncology, Charité Universitätsmedizin Berlin, Campus Rudolf Virchow, Berlin, Germany
10
Department of Hematology, Oncology and Palliative Medicine, Helios Hospital Aue, Aue, Germany
11
Department of Internal Medicine, Hematology, Oncology, Stem Cell Transplantation and Palliative Medicine, Protestant Hospital of Bethel Foundation, Bielefeld, Germany
4
Department I of Internal
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