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Review
. 2025 Jul;39(7):1547-1557.
doi: 10.1038/s41375-025-02586-7. Epub 2025 Apr 9.

Primary antifungal prophylaxis in hematological malignancies. Updated clinical practice guidelines by the European Conference on Infections in Leukemia (ECIL)

Livio Pagano  1   2 , Georg Maschmeyer  3 , Frederic Lamoth  4 , Ola Blennow  5   6 , Alienor Xhaard  7 , Manuela Spadea  8   9 , Alessandro Busca  10 , Catherine Cordonnier  11 , Johan Maertens  12 ; ECIL
Collaborators, Affiliations
Review

Primary antifungal prophylaxis in hematological malignancies. Updated clinical practice guidelines by the European Conference on Infections in Leukemia (ECIL)

Livio Pagano et al. Leukemia. 2025 Jul.

Abstract

At the 10th European Conference on Infections in Leukaemia (ECIL), the guidelines for antifungal prophylaxis in pediatric and adult patients with hematological malignancies (HM) were updated and some changes introduced. Regarding acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) patients undergoing remission induction chemotherapy, a B-II grading has been assigned to isavuconazole, micafungin, and caspofungin, based on non-randomized studies that have shown efficacy in preventing invasive fungal diseases (IFD). Regarding high-risk MDS patients treated with azacytidine, prophylaxis with posaconazole during the first four cycles of treatment is supported in the literature. Prophylaxis is not indicated in patients treated for myeloproliferative neoplasms (NPM), acute lymphoid leukemia (ALL), and Hodgkin lymphoma (HL). For patients with chronic lymphocytic leukemia (CLL) and non-Hodgkin lymphoma (NHL), prophylaxis is not generally indicated. For patients with multiple myeloma (MM), prophylaxis is not indicated and the limited epidemiological data available do not support the use of prophylaxis in subjects treated with bispecific antibodies. For patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT), no substantial changes were made, apart from the addition of isavuconazole with grading B-II in the post-engraftment period. In patients undergoing auto-HSCT, antifungal prophylaxis is not indicated. Previous ECIL guidelines did not include CAR-T cells. The expert panel proposes to endorse the use of anti-mold prophylaxis in high-risk patients during pre-infusion and post-infusion, while in low-risk patients, anti-yeast prophylaxis can be recommended (B-II). For pediatric hematology patients, based on newly published data, caspofungin received a B-I grading as mold-active prophylaxis. Moreover, patients with ALL with insufficient treatment response during induction therapy, and children older than 12 y.o are now considered at high risk for IFD and are recommended to receive antifungal prophylaxis.

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Conflict of interest statement

Competing interests: Livio Pagano (LP) was Board member of Gilead Science, MSD, Pfizer, Menarini-Stemline, Gentili, Jazz Pharmaceutical, Cidara and has received speaker’s honoraria from Gilead Sciences, Kyowa Kirin, MSD, Pfizer Pharmaceuticals, Astellas Pharma, Novartis, Jazz Pharmaceutical, Janseen-Cilag, Astra Zeneca, F2G, Abbvie. Consultant for Menarini, Cidara. Georg Maschmeyer (GM) has received speaker’s honoraria from Gilead Sciences. Frederic Lamoth (FL) reports research funding from Gilead, MSD, Pfizer and Novartis, and honoraria for conferences or advisory boards from Gilead, MSD, Pfizer, Mundipharma and Becton-Dickinson, outside of the submitted work. All contracts were made with and fees paid to his institution (CHUV). Ola Blennow has received speaker’s honoraria from Gilead Sciences. Alienor Xhaard (AX) has received speaker’s honoraria from Merck Sharp and Dohme and Pfizer Pharmaceuticals. Manuela spadea (MS) nothing to declare. Alessandro Busca (AB) was Board member of Gilead Science, Takeda, and has received speaker’s honoraria from Gilead Kite Sciences, MSD, Pfizer Pharmaceuticals, Novartis, Jazz Pharmaceutical, Astra-Zeneca, Abbvie, Menarini Stemline, Takeda. Catherine Cordonnier (CC) has received speaker’s honoraria from Gilead Science and MSD, and consulting fees from Cidara and Mundipharma. Johan Maertens (JM) reports consulting fees from Amplyx, Cidara, Gilead, Pfizer, Scynexis, F2G, Mundipharma, Takeda, and Basilea; Honoraria for lectures from Astellas, Gilead, Basilea, Mundipharma, Takeda, MedScape, Pfizer, and Shionogi; Participation on Advisory Board from Cidara, Pulmocide, Shionogi, Basilea, Sfunga. ECIL members who participated in the drafting of these recommendations: Livio Pagano, Georg Maschmeyer, Frederic Lamoth, Ola Blennow, Alienor Xhaard, Manuela Spadea, Alessandro Busca, Catherine Cordonnier, Johan Maertens.

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References

    1. Cordonnier C, Calandra T. The first European Conference on Infections in Leukaemia: why and how?. Eur J Cancer. 2007;5:2–4–4.
    1. Maertens JA, Frère P, Lass-Flörl C, Heinz W, Cornely OA. Primary antifungal prophylaxis in leukaemia patients. Eur J Cancer. 2007;5:43–48–8.
    1. Maertens J, Marchetti O, Herbrecht R, Cornely OA, Flückiger U, Frêre P, et al. European guidelines for antifungal management in leukemia and hematopoietic stem cell transplant recipients: summary of the ECIL 3–2009 update. Bone Marrow Transpl. 2011;46:709–18. - PubMed
    1. Maertens JA, Girmenia C, Brüggemann RJ, Duarte RF, Kibbler CC, Ljungman P, et al. European guidelines for primary antifungal prophylaxis in adult haematology patients: summary of the updated recommendations from European Conference on Infections in Leukemia. J Antimicrob Chemother. 2018;73:3221–30. - PubMed
    1. Ullmann AJ, Akova M, Herbrecht R, Viscoli C, Arendrup MC, Arikan-Akdagli S, et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: adults with haematological malignancies and after haematopoietic stem cell transplantation (HCT). Clin Microbiol Infect. 2012;18:53–67. - PubMed

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