Control of Fungal Infections After Chemotherapy for Hematologic Diseases and After Hematopoietic Stem Cell Transplantation

For the treatment of hematologic diseases such as acute leukemia and lymphoma, cytotoxic chemotherapy and hematopoietic stem cell transplantation (HSCT) are often used in routine clinical practice. Fungal infections are not only associated with high mortality, but also have a significant impact on the subsequent treatment of hematologic diseases. In general, it is often difficult to make a definitive diagnosis of fungal infections in the field of hematologic diseases. In addition, it is important to accurately assess risk factors for fungal infections, monitor and diagnose, and timely select and administer antifungal medications, including prophylaxis, empiric therapy, early or preemptive therapy, and targeted therapy. The accuracy of monitoring and diagnosis of fungal infections has improved dramatically, and many new antifungal drugs have become available in Japan in recent years. Furthermore, large-scale clinical trials have provided much evidence regarding the efficacy and safety of various antifungal agents for prophylaxis, empiric therapy, early or preemptive therapy, and targeted therapy. While the number of treatment options for fungal infections has increased in recent years, it is also important to make appropriate treatment choices for fungal infections. Inappropriate use of antifungal drugs is a major problem from the perspective of fungal resistance and also from the health economics, and it is necessary to promote their appropriate use. This review focuses on evidence-based interventions for the fungal infections control associated with intensive chemotherapy for hematologic diseases and HSCT, including risk assessment, monitoring and diagnosis, prophylaxis, empiric therapy, early or preemptive therapy, and targeted therapy.