Table 5 Recommendations for allo-HSCT recipients: pre-engraftment.

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

Antifungal agent

Pre-engraftment risk of mold infection

ECIL 5-6

 

low

high

low

High

Fluconazole 400 mg q24h

A-I a

D-III

A-I a

A-III against

Posaconazole tablet 300 mg q24h following a loading dose of 300 mg q12h on day 1 or oral solution 200 mg q8h

B-II

B-II

B-II

B-II

Itraconazole

2.5–7.5 mg/kg q24h i.v. or 200 mg q24h p.o

B-I

B-I

B-I

B-I

Voriconazole 6 mg/kg q12h first day then 4 mg/kg q12h i.v. or p.o.

B-I

B-I

B-I

B-I

Micafungin 50 mg q24h

B-I

C-I

B-I

C-I

Caspofungin and anidulafungin

no data

no data

no data

no data

Liposomal amphotericin B

C-II

 

C-II

C-II

Aerosolized liposomal amphotericin B (10 mg twice weekly) in combination with systemic fluconazole 400 mg q24h

C-III

 

C-III

B-II

Isavuconazole 200 mg q24h following a loading dose of 200 mg q8h on days 1 and 2 b

B-II

B-II

no data

no data

  1. aonly when combined with a mold-directed diagnostic approach (biomarker and/or CT scan-based)or a mold-directed therapeutic approach (empirical antifungal therapy).
  2. bIsavuconazole can be used as second-line mold active prophylaxis, in case of intolerance to posaconazole / voriconazole, or QTc prolongation.
  3. Pre-engraftment risk of mold infection as previously defined: high risk includes active leukemia, cord blood transplantation and unrelated donor [72]. Haplo-identical HSCT using post-transplantation cyclophosphamide should be considered at low risk (B-II) In case of prior IFD, secondary prophylaxis should be tailored according to the previous documentation [73].
  4. HSCT hematopoietic stem cell transplantation.
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