Antifungal prophylaxis in neutropenic patients with hematologic malignancies: Is there a real benefit?

Invasive fungal infections have been reported with an increasing incidence over the last 20 years. Fungal infections are an important cause of morbidi ty and mortality in patients with hematological malignancies. Therefore, in neutropenic patients different regimens of antifungal prophylaxis have bee n performed for more than 20 years, but the effect of antifungal prophylaxi s is controversial. A long duration of neutropenia, impaired cell-mediated immunity as well as continuous corticosteroid therapy and sustained immunos uppression for graft-versus-host disease in patients treated with allogenei c bone marrow transplantation are known risk factors for invasive mycosis. Since early diagnosis of invasive fungal infection is difficult, strategies to prevent fungal infections seem to be attractive. The introduction of tr iazoles have provided us with a better armamentarium to prevent fungal infe ctions. In this review, the current strategies of antifungal prophylaxis ar e discussed. Antifungal prophylaxis has been effective in reducing candida infection, however, there has been no proven successful prevention of invas ive aspergillosis. In addition, there is no clearly proven benefit of antif ungal prophylaxis regarding the reduction in the overall mortality. Thus th e best way to reduce invasive fungal-related mortality will be early diagno sis and preemptive therapeutic approaches.