RECENT FINDINGS: The evolving epidemiologic characteristics of post-HSCT invasive mould
infections, specifically the rising incidence of Aspergillus and non-Aspergillus mould
infections in the postengraftment period, necessitate the development of preventive strategies. The efficacy of prophylactic broad-spectrum
triazoles against invasive mould
infections in HSCT recipients has now been demonstrated in two large prospective studies. However, concerns over
drug absorption, interactions, and costs may shift attention from universal prophylaxis to risk stratification and preemptive strategies. In this regard, recent studies have highlighted the potential of genetic polymorphism analysis to identify HSCT recipients at risk for invasive
aspergillosis, and efforts are underway to improve the predictive values of
antigen and
nucleic acid detection assays. Emerging data on risk factors for invasive
aspergillosis relapse after HSCT, antifungal
drug monitoring, and the use of
galactomannan testing to monitor treatment response may help inform therapeutic decisions for HSCT recipients.
SUMMARY: Evidence-driven management of invasive mould
infections in HSCT recipients is becoming increasingly individualized, integrating host factors and pharmacologic and epidemiologic considerations. However, the optimal approach to invasive mould
infection prevention in HSCT recipients remains to be resolved by prospective clinical studies.