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Updated: Jun 17, 2025

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Challenges and considerations for antifungal prophylaxis in children with acute myeloid leukemia

Daniel K Yeoh1,2,3,4,5, Gabrielle M Haeusler1,3,4,6,7, Monica A Slavin1,3,6

  • 1Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.

Expert Review of Hematology
|August 7, 2024
PubMed
Abstract

Insights

Children with acute myeloid leukemia (AML) need antifungal prophylaxis to prevent invasive fungal disease (IFD). Optimizing this approach requires addressing current agent limitations and considering new AML therapies.

Area of Science:

  • Pediatric Hematology Oncology
  • Infectious Diseases
  • Pharmacology

Background:

  • Children undergoing acute myeloid leukemia (AML) treatment face a high risk of invasive fungal disease (IFD).
  • Antifungal prophylaxis is recommended for pediatric AML patients to mitigate IFD burden.
  • Current antifungal agents present limitations, and comparative data for optimal prophylaxis is scarce.

Purpose of the Study:

  • To review the epidemiology of IFD in pediatric AML patients.
  • To summarize current antifungal prophylaxis recommendations and challenges.
  • To discuss considerations for optimizing antifungal prophylaxis in the evolving landscape of AML therapy.

Main Methods:

  • A literature search was conducted for pediatric studies on IFD and antifungal prophylaxis in AML.
  • Studies published up to December 2023 were included.
  • The review synthesizes findings on current recommendations, challenges, and future directions.

Main Results:

  • Evidence supports antifungal prophylaxis in pediatric AML, but limitations of existing agents exist.
  • Factors like tolerability, pharmacokinetics, administration, and drug interactions are critical.
  • The rise of novel AML therapies necessitates updated prophylactic strategies.

Conclusions:

  • Optimizing antifungal prophylaxis is crucial for vulnerable pediatric AML patients.
  • Well-designed clinical studies are essential to guide the best prophylactic approaches.
  • Future research should focus on new antifungal agents and tailored strategies for pediatric AML.
Keywords:
Acute myeloid leukemiaFLT3 inhibitorsantifungal prophylaxishypomethylating agentsinvasive fungal diseasemenin inhibitorsvenetoclax

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