Some future research questions regarding HSCT in patients with prior IFD
| Future research questions . |
|---|
| Criteria for assessing response to antifungals, role of PET/CT pre-HSCT |
| Role of isolated positive biomarkers (eg, Aspergillus GM, PCR) or serology (eg, Coccidioiodes) pre-HSCT while there is objective clinical evidence of response |
| Diagnosis of IFD relapse in HSCT patient with new fever/infiltrates |
| Immune adjunct therapy as secondary prophylaxis (eg, WBC or fungal-specific T-cell transfusions with or without cytokines) |
| Bridging antifungal strategies for patients with severe mucositis during preengraftment |
| Assessing contributable vs attributable mortality in HSCT recipient who dies post-HSCT |
| Role of new medications for AML relapse post-HSCT (eg, venetoclax) and risk of IFD relapse post-HSCT |
| Role of new medications for GVHD prevention/treatment (eg, ibrutinib) and risk of IFD relapse post-HSCT, interactions with azoles |
| Developing interventional bundles for secondary prevention of IFD relapse post-HSCT |
| Antifungal stewardship issues in HSCT recipients with history of IFD pretransplantation |
| Immunogenetics (donor/recipient) and IFD relapse |
| Clinical score cards, comorbidity indexes, and IFD relapse |
| Effective and cost-beneficial surveillance for IFD relapse in asymptomatic HSCT patients (eg, periodic CT, biomarkers) who are receiving appropriate antifungal prophylaxis |
| Role of new investigational drugs for treatment of IFD peritransplantation (to avoid toxicity, drug-drug interactions) |
| Role of ID consultant in management |
| Chronic toxicities of antifungals given as secondary prophylaxis post-HSCT |
| Applying host disease status biomarkers to monitor for IFD relapse post-HSCT |
| Future research questions . |
|---|
| Criteria for assessing response to antifungals, role of PET/CT pre-HSCT |
| Role of isolated positive biomarkers (eg, Aspergillus GM, PCR) or serology (eg, Coccidioiodes) pre-HSCT while there is objective clinical evidence of response |
| Diagnosis of IFD relapse in HSCT patient with new fever/infiltrates |
| Immune adjunct therapy as secondary prophylaxis (eg, WBC or fungal-specific T-cell transfusions with or without cytokines) |
| Bridging antifungal strategies for patients with severe mucositis during preengraftment |
| Assessing contributable vs attributable mortality in HSCT recipient who dies post-HSCT |
| Role of new medications for AML relapse post-HSCT (eg, venetoclax) and risk of IFD relapse post-HSCT |
| Role of new medications for GVHD prevention/treatment (eg, ibrutinib) and risk of IFD relapse post-HSCT, interactions with azoles |
| Developing interventional bundles for secondary prevention of IFD relapse post-HSCT |
| Antifungal stewardship issues in HSCT recipients with history of IFD pretransplantation |
| Immunogenetics (donor/recipient) and IFD relapse |
| Clinical score cards, comorbidity indexes, and IFD relapse |
| Effective and cost-beneficial surveillance for IFD relapse in asymptomatic HSCT patients (eg, periodic CT, biomarkers) who are receiving appropriate antifungal prophylaxis |
| Role of new investigational drugs for treatment of IFD peritransplantation (to avoid toxicity, drug-drug interactions) |
| Role of ID consultant in management |
| Chronic toxicities of antifungals given as secondary prophylaxis post-HSCT |
| Applying host disease status biomarkers to monitor for IFD relapse post-HSCT |
AML, acute myeloid leukemia; GM, galactomannan; ID, infectious disease; PCR, polymerase chain reaction; WBC, white blood cell.