Related Experiment Video
Updated: Aug 5, 2026
An Ex vivo Assay to Study Candida albicans Hyphal Morphogenesis in the Gastrointestinal Tract
Published on: July 1, 2020
Antifungal Management in Patients with Hematological Malignancies: From Primary Prophylaxis to Empirical and
Vildan Özkocaman1, Tuğcan Alp Kırkızlar2, Gökhan Metan3
1Bursa Uludağ University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Bursa, Türkiye
Abstract:
Invasive fungal diseases (IFDs) remain a significant cause of morbidity and mortality among patients with hematological malignancies, especially those undergoing intensive chemotherapy or hematopoietic stem cell transplantation (HSCT). This text provides a comprehensive risk-adapted framework for antifungal prophylaxis, stratifying patients into high-, intermediate-, and low-risk categories. Mold-active prophylaxis, primarily with posaconazole, is recommended for high-risk patients such as those with acute myeloid leukemia during remission induction or those with grade III-IV graft-versus-host disease following allogeneic HSCT. Fluconazole remains an option for yeast-active prophylaxis in intermediate-risk patients, while low-risk groups generally do not require prophylaxis. The evolving landscape of targeted therapies such as venetoclax, FMS-like tyrosine kinase 3 inhibitors, and CD19 chimeric antigen receptor T-cell (CAR-T) therapy poses new challenges, particularly due to drug-drug interactions with triazole antifungals. In patients receiving venetoclax, azole co-administration necessitates significant dose adjustments. We also present algorithms for antifungal management in the context of CD19 CAR-T therapy and novel agents, emphasizing the role of individualized risk assessment. Beyond prophylaxis, timely diagnosis and early treatment of IFDs are critical. The role of thoracic computed tomography, serum and bronchoalveolar lavage galactomannan, and fungal biomarkers is discussed within diagnostic-driven strategies. We outline treatment pathways for suspected pulmonary or sinus fungal infections, including when to escalate antifungal therapy or consider surgical intervention. This content offers a practical and evidence-based guide for clinicians navigating antifungal strategies in a rapidly changing therapeutic landscape, aiming to reduce IFD-related mortality while balancing toxicity, resistance, and healthcare costs.
Insights
This review details a risk-adapted framework for antifungal prophylaxis in patients with hematologic malignancies, addressing challenges from new therapies and guiding IFD management.
Area of Science:
- Hematology
- Infectious Diseases
- Pharmacology
Background:
- Invasive fungal diseases (IFDs) are a major cause of death in patients with hematologic malignancies, especially after chemotherapy or stem cell transplant.
- New targeted therapies present challenges for antifungal prophylaxis due to drug interactions.
Purpose of the Study:
- To provide a comprehensive, risk-adapted framework for antifungal prophylaxis and management of IFDs in patients with hematologic malignancies.
- To address challenges posed by novel targeted therapies and drug-drug interactions with antifungals.
Main Methods:
- Review of current literature and guidelines on antifungal prophylaxis and treatment.
- Stratification of patients into high, intermediate, and low-risk categories for IFD.
- Development of algorithms for antifungal management in the context of novel therapies like venetoclax and CAR-T therapy.
Main Results:
- Recommends mold-active prophylaxis (e.g., posaconazole) for high-risk patients (e.g., AML, GVHD post-HSCT).
- Suggests fluconazole for intermediate-risk patients; low-risk patients may not need prophylaxis.
- Highlights need for dose adjustments with venetoclax and azoles; provides management algorithms for CD19 CAR-T therapy.
Conclusions:
- A risk-adapted approach to antifungal prophylaxis and management is crucial for reducing IFD-related mortality in hematologic malignancy patients.
- Individualized risk assessment and careful consideration of drug-drug interactions are essential when using novel therapies.
- Timely diagnosis and early treatment, including diagnostic-driven strategies and surgical intervention when necessary, are critical for optimal outcomes.
Related Concept Videos
01:27Cryptococcal Meningitis
01:15Antifungal Agents
01:20Candidiasis
01:29Therapeutic Drug Monitoring: Affecting Factors
02:50Combination Therapies and Personalized Medicine
The combination of the drug acetazolamide and sulforaphane is a good example of combination therapy to treat cancer. The cells in the interior of a large tumor often die due to the hypoxic and...
01:28Pulmonary Tuberculosis V
Latent tuberculosis infection occurs when TB bacteria are present in a person's body, but are not causing illness or symptoms. It is not contagious, and preventive treatment is crucial to avoid the progression...