Managing Invasive Fungal Infections During Allogeneic Hematopoietic Transplantation: A 2025 Update

Area of Science:

• Mycology
• Infectious Diseases
• Hematology

Background:

• Invasive fungal infections (IFIs) pose a serious risk, particularly for immunocompromised individuals, leading to high morbidity and mortality.
• IFI prevalence ranges from 7-15%, influenced by evolving treatment strategies and the emergence of specific fungal pathogens.
• Risk factors for IFIs encompass hematological malignancies, patient lifestyle, and transplant-related characteristics.

Purpose of the Study:

• To review current strategies for prophylaxis and treatment of invasive fungal infections (IFIs) in high-risk patients.
• To highlight shifts in IFI epidemiology, noting decreased invasive candidiasis and increased aspergillosis.
• To discuss the role of existing and emerging antifungal agents in managing IFIs.

Main Methods:

• Literature review of current guidelines and epidemiological data on IFIs.
• Analysis of risk factors associated with IFIs in immunocompromised hosts.
• Evaluation of antifungal prophylaxis and treatment recommendations, including drug-specific considerations.

Main Results:

• Invasive candidiasis is decreasing, while invasive aspergillosis is increasing in high-risk populations.
• Prophylaxis strategies vary based on local epidemiology and engraftment status, with specific recommendations for pre- and post-engraftment periods.
• Voriconazole remains a primary treatment for invasive aspergillosis, despite concerns regarding adverse events and drug interactions.

Conclusions:

• Current international guidelines provide a framework for IFI management, emphasizing appropriate antifungal prophylaxis and treatment.
• The evolving landscape of IFIs necessitates continuous reassessment of therapeutic strategies.
• Emerging antifungal molecules show promise for improved efficacy and tolerability in managing IFIs.