Onkológia 3/2026

When prophylaxis fails: invasive fungal diseases in leukemia in clinical practice

Invasive fungal diseases represent potentially life-threatening infectious complications, particularly in patients with acute leukemias. The successful implementation of azole-based antifungal prophylaxis has significantly altered the epidemiology of fungal infections and resistance patterns in many healthcare facilities. As the use of prophylaxis has expanded, the problem of breakthrough invasive fungal infections has also increased. The presence of neutropenia, intensive chemotherapy with subsequent mucositis, graft-versus-host disease (GvHD), corticosteroid therapy and iron overload are considered the main risk factors for these infections. Early diagnosis and treatment are key to reducing morbidity and mortality and currently rely heavily on the detection of fungal biomarkers, DNA, and imaging studies. However, the development of targeted anticancer therapy brings an increased risk of drug interactions between antifungals and new therapeutics metabolized via cytochrome P450 (CYP3A4). Effective management of these diseases therefore requires a multidisciplinary approach, early diagnosis, individualized treatment, and rigorous „antifungal stewardship“.

Keywords: invasive fungal diseases, antimycotic prophylaxis, acute myeloid leukemia, invasive aspergillosis, breakthrough invasive fungal diseases