Hull York Medical School University of Hull University of York University of Liverpool Hull University Teaching Hospital NHS Trust King's College Hospital NHS Foundation Trust


Why are we doing this study?

Antifungal resistance is a growing concern worldwide, it is vital to find the best way to reduce antifungal use without increasing fungal infections. Blood tests can be used to detect fungal infections early, before they cause symptoms or harm to the patient. The two blood tests we are looking at are called beta-D-glucan and galactomannan, both of which are made by the fungi. If one or both blood tests become positive, it may be a sign that a fungal infection is developing and further tests and treatment are required. We want to find out if monitoring the risk of fungal infections by regular blood tests is safe and reduces antifungal use but does not reduce patient quality of life or increase fungal infections.

What is ‘antifungal resistance’ and ‘antifungal stewardship’?

Antifungal resistance means the antifungal drugs are no longer effective.  It happens when certain fungi develop resistance to the antifungal drugs used to prevent or treat the infections fungi can cause. Resistant fungi are spreading worldwide and are a serious concern, with an increased risk of mortality. Antifungal Stewardship is about responsible use of antifungal drugs in a way that focuses on treating patients with the right drug whilst preserving the future effectiveness of the drug and minimising harm to the patient and healthcare costs. Currently most antifungal drugs prescribed in hospitals are for patients who have blood cancers such as AML / MDS / ALL / tMPN.

How common are invasive fungal infections in patients with AML / MDS / ALL / tMPN?

The risk of invasive fungal infection depends on the type of blood cancer and the type of chemotherapy being used. Chemotherapy lowers the numbers of white cells in your blood that fight infection, the lower the count and longer it remains low the higher the chance of infection. About 1 in 10 to 1 in 20 patients (5-10%) undergoing intensive chemotherapy will get a serious fungal infection.

How are antifungal medications currently used in patients with AML / MDS / ALL / tMPN?

Different ways have been used to prevent fungal infection in AML / MDS / ALL / tMPN. Drugs called antifungals are often given as a preventive (prophylaxis). This is the usual way to prevent fungal infection in AML / MDS / ALL / tMPN. This approach means that all patients take a drug to prevent a small total number of fungal infections. Sometimes patients who develop a persistent fever during chemotherapy are given antifungal drugs for suspected fungal infections, but we know that most of the time a fungal infection is not present. The drugs used to treat fungal infections can have side effects and may interact with other drugs so we need better ways of deciding which patients do have a fungal infection so we can target treatment at these patients only. Overuse of antifungal drugs may also have serious consequences for the health service and wider society in terms of increasing antifungal resistance and costs. Discussions with patients with experience of AML / MDS / ALL / tMPN informed us that the number of drugs they take can be a burden.