MANAGING INVASIVE FUNGAL INFECTIONS DURING ALLOGENEIC HEMATOPOIETIC TRANSPLANTATION: A 2025 UPDATE
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Keywords
Antifungal agents, antifungal prophylaxis, Invasive fungal infections, Invasive Aspergillosis, Candida, Allogeneic hematopoietic cell transplantation
Abstract
Invasive fungal infections (IFIs) mostly affect immunocompromised hosts and are responsible for high rates of complications and mortality. Prevalence of IFIs has been reported between 7 and 15% and is evolving due to the introduction of new drugs in the prophylaxis of high-risk patients. Invasive candidiasis has become less frequent, while cases of aspergillosis are increasing. The most important risk factors for IFIs can be divided into 3 categories: those related to the hematological neoplasm, those related to the patient's lifestyle, and those dictated by the transplant characteristics. In high-risk patients, prophylaxis is driven by both local epidemiology and time of the engraftment. In the pre-engraftment period there is a wide spectrum of drugs that could be chosen as antifungal, while in the post-engraftment period posaconazole is recommended for patients presenting GvHD undergoing immunosuppression. Regarding treatment, voriconazole is still the recommended drug for invasive aspergillosis, although adverse events, toxicity, and drug interactions are particularly relevant. In the management of IFIs, international guidelines recommend the best drugs for prophylaxis and treatment, but the future holds new molecules that are already demonstrating excellent efficacy and tolerability.
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Aug 31, 2025
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Quattrone, M. (2025) “ MANAGING INVASIVE FUNGAL INFECTIONS DURING ALLOGENEIC HEMATOPOIETIC TRANSPLANTATION: A 2025 UPDATE”, Mediterranean Journal of Hematology and Infectious Diseases, 17(1), p. e2025064. doi: 10.4084/MJHID.2025.064.
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