# Antifungal prophylaxis in high-risk patients with hematologic malignancy: a comparison of practice and guidelines in Türkiye

## TL;DR

This study compares antifungal prophylaxis practices with guidelines among high-risk hematologic malignancy patients in Türkiye, finding significant inconsistencies.

## Contribution

The study reveals discrepancies between clinical practice and guidelines for antifungal prophylaxis in high-risk hematologic malignancy patients in Türkiye.

## Key findings

- Physicians in Türkiye often deviate from guideline-recommended timing and duration of antifungal prophylaxis.
- Posaconazole is the most commonly used drug for antifungal prophylaxis despite guideline inconsistencies.
- Breakthrough fungal infections remain common despite prophylactic measures in high-risk patients.

## Abstract

Primary antifungal prophylaxis (AFP) is as considered the gold standard therapy for patients with hematologic malignancies based on the available guidelines. The aim behind this study was to investigate the level of guideline knowledge and the translation of guideline recommendations into real-life settings among physicians in Türkiye.

In this prospective, observational study, the physicians’ knowledge of AFP guideline recommendations for patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) undergoing first remission-induction (Group I) or graft-versus-host-disease (GvHD) after allogeneic stem cell transplant (Group II) was compared with clinical practice via an 11-item multiple-choice questionnaire evaluating the patients in whom AFP was initiated, the timing, the AFP duration, and the drugs used.

The mean patient age was 48.3 years and 79% had AML/MDS. AFP was initiated in 75.3% of Group I patients on the first day of induction chemotherapy before baseline and in 26.2% of Group II patients at baseline. For 98.8% of the Group I patients, the physician’s plan was to continue AFP until recovery from neutropenia and complete remission (CR), whereas it was to be used during immunosuppression in Group II. The median (IQR) duration of AFP was 0.8 (0.5–1.9) and 5.5 (2.4–8.1) months for Groups I and II, respectively. Breakthrough invasive fungal infections (bIFIs) were observed in 35.8% and 14.3% of Groups I and II, respectively.

The mean survey scores were 8.5 ± 2.3 for the AML/MDS patient group and 9.9 ± 3.2 for the GvHD patient group. Most of the surveyed sites adhered to the guidelines from the European Conference on Infections in Leukemia (80.6%), followed by the fever and neutropenia guidelines of the Infectious Diseases Society of America (51.6%). Posaconazole was the drug of choice in both groups (96.8% in Group I vs. 71% in Groups II).

The data indicate an inconsistency between real-life clinical practice and the guideline recommendations for primary AFP and bIFI management in high-risk patients with hematologic malignancies in Türkiye.