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While antifungal prophylaxis with triazoles remains standard for patients receiving intensive chemotherapy, this paradigm may no longer apply to those treated with novel regimens. Targeted agents such as tyrosine kinase inhibitors, blinatumomab, inotuzumab ozogamycin, ivosidenib, gilteritinib, and venetoclax are associated with higher remission rates, shorter or absent neutropenia, and minimal mucosal injury\u2014key determinants of IFD risk. As a result, the incidence of IFD appears markedly lower in such populations. Redefining antifungal prophylactic strategies must account for this therapeutic heterogeneity to avoid overexposure to antifungal drugs and misdirected research priorities. Updated, risk-adapted strategies\u2014integrating treatment intensity, myelotoxicity, and drug interactions\u2014are essential to define which AL patients truly benefit from primary antifungal prophylaxis in the modern era.<\/jats:p>","DOI":"10.1093\/jac\/dkag010","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T12:39:55Z","timestamp":1767875995000},"source":"Crossref","is-referenced-by-count":0,"title":["Redefining antifungal prophylaxis in acute leukaemia in the era of targeted therapies"],"prefix":"10.1093","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4867-0014","authenticated-orcid":false,"given":"Marcio","family":"Nucci","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Universidade Federal do Rio de Janeiro and Grupo Oncoclinicas , Rua Assun\u00e7\u00e3o 159 Bl 2 Apt 801, Rio de Janeiro 22251-030 ,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johan","family":"Maertens","sequence":"additional","affiliation":[{"name":"Department of Hematology, University Hospitals Leuven , Leuven ,","place":["Belgium"]},{"name":"Department of Microbiology, Immunology, and Transplantation, KU Leuven , Herestraat 49, Leuven 3000 ,","place":["Belgium"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"2026011902083322600_dkag010-B1","doi-asserted-by":"publisher","first-page":"2206","DOI":"10.1080\/10428194.2022.2060504","article-title":"Epidemiology of invasive fungal diseases in adults with newly diagnosed acute myeloid leukemia","volume":"63","author":"Miranti","year":"2022","journal-title":"Leuk Lymphoma"},{"key":"2026011902083322600_dkag010-B2","doi-asserted-by":"publisher","first-page":"myaf070","DOI":"10.1093\/mmy\/myaf070","article-title":"Epidemiological shifts of invasive fungal infections in the current era of haematology","volume":"63","author":"Monzo-Gallo","year":"2025","journal-title":"Med Mycol"},{"key":"2026011902083322600_dkag010-B3","doi-asserted-by":"publisher","first-page":"e70121","DOI":"10.1002\/hon.70121","article-title":"Real world incidence and etiology of infectious complications in adults with ph-negative acute lymphoblastic leukemia treated with the pediatric-inspired GIMEMA LAL1913 program. 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