Invasive fungal infections are important causes of morbidity and mortality among patients receiving cancer chemotherapy or undergoing bone marrow or stem-cell transplantation. The infections are often difficult to diagnose and frequently progress rapidly. Diagnosis is hampered by the lack of reliable diagnostic tools that would enable clinicians to identify and treat the infection early rather than when it is far advanced and less likely to respond to treatment. Newly developed antifungal drugs now offer more effective and less toxic options, and recent advances in the use of noninvasive assays such as galactomannan and beta glucan and CT scans, while not infallible, suggest novel approaches to improve diagnostic and therapeutic outcomes. One such approach is to view the progression of an invasive fungal infection as a continuum from the absence of disease to full blown disease and its sequelae. To date markers along that continuum have been prophylaxis in the high-risk patient, empirical therapy in the high-risk patient with a fever and receiving antibiotics, and therapy for proven fungal infection. Current knowledge of invasive fungal infections combined with a wider choice of therapeutic agents and the availability of better diagnostic tools offer clinicians opportunities to consider intervening at different points along the continuum, possibly yielding better clinical results. This educational activity explores an approach to potentially more effective treatment of invasive fungal infections in blood or marrow transplant recipients and patients receiving cancer chemotherapy. Using a case study presentation with discussion of alternative actions at critical points during the description of the patient's course, the faculty evaluate various treatment options and present the positive and negative aspects of each, citing evidenced-based criteria as support for their choices.

This symposium should be of benefit to hematologists/oncologists and other healthcare professionals involved in the treatment of hematopoietic stem cell transplant recipients.

After participating in this program, participants should be able to

• Describe the type and clinical parameters of each stage along the antifungal therapy continuum
  
• Differentiate the clinical applications of empirical and presumptive therapy

John R. Wingard, MD, Chair
Price Eminent Scholar and Professor of Medicine
Director of Blood and Bone Marrow Transplantation Program
Division of Hematology/Oncology
Deputy Director, Gainesville Campus of University of Florida Shands Cancer Center
University of Florida College of Medicine
Gainesville, Florida

Eric J. Bow, MD
Professor and Head
Section of Haematology/Oncology
Department of Internal Medicine
University of Manitoba Faculty of Medicine
Head, Department of Medical Oncology and Haematology
Director, Infection Control Services
CancerCare Manitoba
Winnipeg, Manitoba, Canada

John W. Hiemenz, MD, FIDSA
Professor of Medicine
Head, Infectious Diseases Research Program
Director, Hematologic Malignancies and BMT Program
Feist-Weiller Cancer Center
Louisiana State University Health Sciences Center
Shreveport, Louisiana

The Medical College of Wisconsin is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

In compliance with the Standards for Commercial Support of Continuing Medical Education of the Accreditation Council for Continuing Medical Education, the Medical College of Wisconsin informs CME participants of any significant financial interest or other relationship a faculty member or the College has with the manufacturer(s) of any commercial product(s) discussed in the CME activity. In addition, faculty members are expected to disclose discussion of an unlabeled use of a commercial product, or an investigational use not yet approved for any purpose.

The following financial relationships are reported for Treatment Continuum for Invasive Fungal Infections: Empirical vs Presumptive Therapy in HSCT Recipients, Sunday, February 19, 2006, Honolulu, Hawaii.

Unrestricted educational grant to the Medical College of Wisconsin from Pfizer Inc.

John R. Wingard, MD
Grants/Research Support: Astellas Pharma Inc.; Merck & Co., Inc.; Ortho-McNeil Pharmaceutical, Inc.; Pfizer Inc; Schering-Plough Corporation
Consultant: Enzon Pharmaceuticals, Inc.; Merck & Co., Inc.; Pfizer Inc.
Speakers' Bureau: Enzon Pharmaceuticals, Inc.; Merck & Co., Inc.; Pfizer Inc.

Dr Wingard has indicated that he will not be discussing the off-label and/or investigational use of antifungal agents.

Eric J. Bow, MD
Grants/Research Support: Astellas Pharma Inc., Pfizer Inc., Wyeth-Ayerst Laboratories
Consultant/Advisory Board: Amgen Inc., Astellas Pharma Inc., Enzon Pharmaceuticals, Inc., Merck-Frosst Ltd., Pfizer Inc., Schering-Plough Corporation.
Speakers' Bureau: Wyeth-Ayerst Laboratories

Dr Bow has indicated that he will not be discussing the off-label and/or investigational use of antifungal agents.

John W. Hiemenz, MD
Grants/Research Support: Astellas Pharma Inc., Merck & Co., Inc.
Consultant: Merck & Co., Inc.
Speakers' Bureau: Astellas Pharma Inc., Merck & Co., Inc., Pfizer Inc.
Consultant: Merck & Co., Inc., Pfizer Inc.

Dr Hiemenz has indicated that he will describe the off-label and/or investigational use of empirical antifungal therapy with voriconazole.