Alice Han
@dralicehan.bsky.social
ID physician at MIDC - transforming private practice ID with an academic and lifestyle focus. Opinions my own👩🏻⚕️🧫🩺 #Medsky #IDsky
I am still catching up but I really enjoyed this one. Very helpful to go through cases and the decision making involved. The cmv case provided more clarity for me as those cases are very challenging
October 24, 2025 at 12:57 AM
I am still catching up but I really enjoyed this one. Very helpful to go through cases and the decision making involved. The cmv case provided more clarity for me as those cases are very challenging
#IDsky
Sometimes the best part of the conferences are the Q&A sessions afterwards
-Someone asked what do you do with pts colonized with MDRO’s prior to transplant
-Dr Papanicolau creates a detailed abx plan for when pt has a neutropenic fever
-Someone said that they decolonize w/ oral gentamicin 🤯
Sometimes the best part of the conferences are the Q&A sessions afterwards
-Someone asked what do you do with pts colonized with MDRO’s prior to transplant
-Dr Papanicolau creates a detailed abx plan for when pt has a neutropenic fever
-Someone said that they decolonize w/ oral gentamicin 🤯
October 22, 2025 at 11:06 PM
#IDsky
Sometimes the best part of the conferences are the Q&A sessions afterwards
-Someone asked what do you do with pts colonized with MDRO’s prior to transplant
-Dr Papanicolau creates a detailed abx plan for when pt has a neutropenic fever
-Someone said that they decolonize w/ oral gentamicin 🤯
Sometimes the best part of the conferences are the Q&A sessions afterwards
-Someone asked what do you do with pts colonized with MDRO’s prior to transplant
-Dr Papanicolau creates a detailed abx plan for when pt has a neutropenic fever
-Someone said that they decolonize w/ oral gentamicin 🤯
October 22, 2025 at 10:56 PM
Posa vs itra/flu during induction showed clear benefit in development of IFI
October 22, 2025 at 10:55 PM
Posa vs itra/flu during induction showed clear benefit in development of IFI
So what do we do?
Continue antifungal drug for at least 4 weeks and until PMN recovery and objective s/sx of improvement and then switch to secondary antifungal ppx with anti- mold activity
Consider reduced intensity conditioning regimen
Continue antifungal drug for at least 4 weeks and until PMN recovery and objective s/sx of improvement and then switch to secondary antifungal ppx with anti- mold activity
Consider reduced intensity conditioning regimen
October 22, 2025 at 10:54 PM
So what do we do?
Continue antifungal drug for at least 4 weeks and until PMN recovery and objective s/sx of improvement and then switch to secondary antifungal ppx with anti- mold activity
Consider reduced intensity conditioning regimen
Continue antifungal drug for at least 4 weeks and until PMN recovery and objective s/sx of improvement and then switch to secondary antifungal ppx with anti- mold activity
Consider reduced intensity conditioning regimen
Despite this, keep in mind that more than 2/3 remain alive with pre SCT IA, and the allo SCT is potentially curative.
We have to weigh the risk of relapsed AML, losing out transplant window, having underlying disease undermine our efforts to control the infection.
We have to weigh the risk of relapsed AML, losing out transplant window, having underlying disease undermine our efforts to control the infection.
October 22, 2025 at 10:54 PM
Despite this, keep in mind that more than 2/3 remain alive with pre SCT IA, and the allo SCT is potentially curative.
We have to weigh the risk of relapsed AML, losing out transplant window, having underlying disease undermine our efforts to control the infection.
We have to weigh the risk of relapsed AML, losing out transplant window, having underlying disease undermine our efforts to control the infection.
Major prognostic determinants of IFD relapse post HSCT
How to make a risk calculation in your 🧠
How to make a risk calculation in your 🧠
October 22, 2025 at 10:54 PM
Major prognostic determinants of IFD relapse post HSCT
How to make a risk calculation in your 🧠
How to make a risk calculation in your 🧠
Risk factors associated with invasive fungal infection include duration of neutropenia, time from IFI and HSCT, type of antifungal used, and presence of GVHD. And recurrent IFI was associated with higher mortality
October 22, 2025 at 10:42 PM
Risk factors associated with invasive fungal infection include duration of neutropenia, time from IFI and HSCT, type of antifungal used, and presence of GVHD. And recurrent IFI was associated with higher mortality
#IDsky
AML is the primary hematologic malignancy associated with invasive fungal infection
What a great slide looking at the mutations we see in AML, very rare pts with MRD post induction and not need to proceed with allo HSCT as shown in green box
AML is the primary hematologic malignancy associated with invasive fungal infection
What a great slide looking at the mutations we see in AML, very rare pts with MRD post induction and not need to proceed with allo HSCT as shown in green box
October 22, 2025 at 10:42 PM
#IDsky
AML is the primary hematologic malignancy associated with invasive fungal infection
What a great slide looking at the mutations we see in AML, very rare pts with MRD post induction and not need to proceed with allo HSCT as shown in green box
AML is the primary hematologic malignancy associated with invasive fungal infection
What a great slide looking at the mutations we see in AML, very rare pts with MRD post induction and not need to proceed with allo HSCT as shown in green box
#IDsky
Deasy et al showed that inoculation w neisseria lactamica reduced meningococcal carriage from 24% -> 14%
Will we be looking at snot🤧👃 microbiota transplants in the future?
doi.org/10.1093/cid/...
Deasy et al showed that inoculation w neisseria lactamica reduced meningococcal carriage from 24% -> 14%
Will we be looking at snot🤧👃 microbiota transplants in the future?
doi.org/10.1093/cid/...
October 22, 2025 at 8:58 PM
#IDsky
Deasy et al showed that inoculation w neisseria lactamica reduced meningococcal carriage from 24% -> 14%
Will we be looking at snot🤧👃 microbiota transplants in the future?
doi.org/10.1093/cid/...
Deasy et al showed that inoculation w neisseria lactamica reduced meningococcal carriage from 24% -> 14%
Will we be looking at snot🤧👃 microbiota transplants in the future?
doi.org/10.1093/cid/...
#IDsky
Fascinating lecture on the respiratory microbiome
Our understanding of the resp microbiome has changes dramatically but the commensals may actually be protective against pathogenic bacteria
Fascinating lecture on the respiratory microbiome
Our understanding of the resp microbiome has changes dramatically but the commensals may actually be protective against pathogenic bacteria
October 22, 2025 at 8:58 PM
#IDsky
Fascinating lecture on the respiratory microbiome
Our understanding of the resp microbiome has changes dramatically but the commensals may actually be protective against pathogenic bacteria
Fascinating lecture on the respiratory microbiome
Our understanding of the resp microbiome has changes dramatically but the commensals may actually be protective against pathogenic bacteria
Final conclusions
Recommends posa or isavu because of side effect profile
For refractory cases, consider azole switch, l-amb, combination therapy.
Still waiting for further findings for Olorofilm
Recommends posa or isavu because of side effect profile
For refractory cases, consider azole switch, l-amb, combination therapy.
Still waiting for further findings for Olorofilm
October 22, 2025 at 12:46 PM
Final conclusions
Recommends posa or isavu because of side effect profile
For refractory cases, consider azole switch, l-amb, combination therapy.
Still waiting for further findings for Olorofilm
Recommends posa or isavu because of side effect profile
For refractory cases, consider azole switch, l-amb, combination therapy.
Still waiting for further findings for Olorofilm
#IDsky
What about new agents? Olorofilm did fairly well in this particular population who had refractory disease or drug intolerance to other agents
But 10% with hepatotoxicity
But I think it did not get FDA approval in 2023 from what I remember so investigation is still ongoing
What about new agents? Olorofilm did fairly well in this particular population who had refractory disease or drug intolerance to other agents
But 10% with hepatotoxicity
But I think it did not get FDA approval in 2023 from what I remember so investigation is still ongoing
October 22, 2025 at 12:46 PM
#IDsky
What about new agents? Olorofilm did fairly well in this particular population who had refractory disease or drug intolerance to other agents
But 10% with hepatotoxicity
But I think it did not get FDA approval in 2023 from what I remember so investigation is still ongoing
What about new agents? Olorofilm did fairly well in this particular population who had refractory disease or drug intolerance to other agents
But 10% with hepatotoxicity
But I think it did not get FDA approval in 2023 from what I remember so investigation is still ongoing
Evidence for combo therapy
October 22, 2025 at 12:46 PM
Evidence for combo therapy
Repeat BAL aspergillus Ag was strongly positive
So since this pt was on posa -> switch to isavu +|- echinocandin
Perhaps if critically ill, consider ambisome
Experts mention considering next gen sequencing to see if this is actually A. Fumigatus
So since this pt was on posa -> switch to isavu +|- echinocandin
Perhaps if critically ill, consider ambisome
Experts mention considering next gen sequencing to see if this is actually A. Fumigatus
October 22, 2025 at 12:37 PM
Repeat BAL aspergillus Ag was strongly positive
So since this pt was on posa -> switch to isavu +|- echinocandin
Perhaps if critically ill, consider ambisome
Experts mention considering next gen sequencing to see if this is actually A. Fumigatus
So since this pt was on posa -> switch to isavu +|- echinocandin
Perhaps if critically ill, consider ambisome
Experts mention considering next gen sequencing to see if this is actually A. Fumigatus
In this case vignette, pt w/AML and invasive aspergillosis was started on posa and dose of ivosidenib was reduced. But pt’s imaging got worse after 3 weeks
So is it failure of drug vs immune reconstitution? Drug levels therapeutic
This pt was still persistently neutropenic so bronch was repeated
So is it failure of drug vs immune reconstitution? Drug levels therapeutic
This pt was still persistently neutropenic so bronch was repeated
October 22, 2025 at 12:37 PM
In this case vignette, pt w/AML and invasive aspergillosis was started on posa and dose of ivosidenib was reduced. But pt’s imaging got worse after 3 weeks
So is it failure of drug vs immune reconstitution? Drug levels therapeutic
This pt was still persistently neutropenic so bronch was repeated
So is it failure of drug vs immune reconstitution? Drug levels therapeutic
This pt was still persistently neutropenic so bronch was repeated
But keep in mind, pts resistant to vori tend to be resistant also to isavu, and pts resistant to itra tend to be resistant to posa
October 22, 2025 at 12:23 PM
But keep in mind, pts resistant to vori tend to be resistant also to isavu, and pts resistant to itra tend to be resistant to posa
What about azole resistance?
Becoming more common in western Europe
Second slide shows azole resistance rates in chronic aspergillosis pts who had azole exposure
Becoming more common in western Europe
Second slide shows azole resistance rates in chronic aspergillosis pts who had azole exposure
October 22, 2025 at 12:23 PM
What about azole resistance?
Becoming more common in western Europe
Second slide shows azole resistance rates in chronic aspergillosis pts who had azole exposure
Becoming more common in western Europe
Second slide shows azole resistance rates in chronic aspergillosis pts who had azole exposure
#IDsky
Any role in combination antifungal therapy?
This study showed no difference with combined vs monotherapy at 6 and 12 wks although there may be a subset of pts w/+serum/BAL Aspergillus GM who had a benefit
Any role in combination antifungal therapy?
This study showed no difference with combined vs monotherapy at 6 and 12 wks although there may be a subset of pts w/+serum/BAL Aspergillus GM who had a benefit
October 22, 2025 at 12:23 PM
#IDsky
Any role in combination antifungal therapy?
This study showed no difference with combined vs monotherapy at 6 and 12 wks although there may be a subset of pts w/+serum/BAL Aspergillus GM who had a benefit
Any role in combination antifungal therapy?
This study showed no difference with combined vs monotherapy at 6 and 12 wks although there may be a subset of pts w/+serum/BAL Aspergillus GM who had a benefit
Posa vs vori showed fairly similar results as well
6 week mortality ~20%
Also a strong CYP3A4 inhibitor
Fewer treatment related events but can see pseudohyperaldosteronism
6 week mortality ~20%
Also a strong CYP3A4 inhibitor
Fewer treatment related events but can see pseudohyperaldosteronism
October 22, 2025 at 12:16 PM
Posa vs vori showed fairly similar results as well
6 week mortality ~20%
Also a strong CYP3A4 inhibitor
Fewer treatment related events but can see pseudohyperaldosteronism
6 week mortality ~20%
Also a strong CYP3A4 inhibitor
Fewer treatment related events but can see pseudohyperaldosteronism
#IDsky
SECURE trial showed similar efficacy comparing vori vs isavu
Isavu is far better tolerated, not necessary to check levels, lft abnormalities and visual sx less common
- shortens qtc
SECURE trial showed similar efficacy comparing vori vs isavu
Isavu is far better tolerated, not necessary to check levels, lft abnormalities and visual sx less common
- shortens qtc
October 22, 2025 at 12:16 PM
#IDsky
SECURE trial showed similar efficacy comparing vori vs isavu
Isavu is far better tolerated, not necessary to check levels, lft abnormalities and visual sx less common
- shortens qtc
SECURE trial showed similar efficacy comparing vori vs isavu
Isavu is far better tolerated, not necessary to check levels, lft abnormalities and visual sx less common
- shortens qtc
But remember that vori can cause sig drug drug interactions and there is interindividual variability in pts (rapid metabolizers and ultra rapid metabolizers)
- need to monitor levels
- vision changes (flashing lights)
- photosensitivity (use sunscreen)
- need to monitor levels
- vision changes (flashing lights)
- photosensitivity (use sunscreen)
October 22, 2025 at 9:58 AM
But remember that vori can cause sig drug drug interactions and there is interindividual variability in pts (rapid metabolizers and ultra rapid metabolizers)
- need to monitor levels
- vision changes (flashing lights)
- photosensitivity (use sunscreen)
- need to monitor levels
- vision changes (flashing lights)
- photosensitivity (use sunscreen)