Risk-based antifungal prophylaxis in hematologic malignancy and stem cell transplantation

Invasive fungal infection (IFI) is an important cause of morbidity and mortality in patients with hematologic malignancy, prolonged neutropenia, or after hematopoietic stem cell transplant. Antifungal prophylaxis prevents IFI in high-risk hematology patients. This article discusses recent developments in antifungal prophylaxis, focusing on those expected to affect patient management. Significant advances have occurred in understanding risk stratification and assessment of individual patient risk for drug-drug interactions, toxicity, or variations in pharmacokinetics; choice of antifungal prophylaxis strategy, drug, dose, route, and regimen; therapeutic drug monitoring; cost effectiveness of prophylaxis; and the significance of breakthrough IFI. Research over the coming decade is likely to fundamentally alter antifungal prophylaxis by allowing clinicians to make individualized decisions for their patients informed by rapid, detailed, and personalized risk-benefit analyses.