Table 6 Recommendations for allo-HSCT recipients: post-engraftment.

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

Antifungal agent

Steroid treated acute GVHD

ECIL 5-6

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

A-I a, b

A-I a, b

Itraconazole

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

B-I b

B-I b

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

B-I b

B-I b

Micafungin 50 mg q24h

C-II

C-II

Caspofungin and anidulafungin

no data

no data

Liposomal amphotericin B

C-II

C-II

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

no data

no data

Fluconazole 400 mg q24h

D-III

D-III

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

B-II

no data

  1. After engraftment, in patients without GVHD, fluconazole can be continued until D + 75.
  2. a No difference compared with placebo was seen in patients with chronic GVHD.
  3. b It is recommended to monitor serum drug concentration.
  4. c Isavuconazole can be used as second-line mold active prophylaxis, in case of intolerance to posaconazole/voriconazole, or QTc prolongation.