{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T19:45:01Z","timestamp":1791402301410,"version":"4.3.3"},"reference-count":21,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Adult acute lymphoblastic leukemia (ALL) patients are at increased risk of invasive fungal infections (IFIs) due to intensive therapy and prolonged neutropenia. While pediatric guidelines support administering fluconazole or mold-active agents, the evidence in adults is limited. This study presents the first multicenter retrospective comparison of fluconazole and micafungin use in this setting. Methods: We retrospectively analyzed 336 adult ALL patients from 11 centers in T\u00fcrkiye (2010\u20132024) who received fluconazole (n = 230) or micafungin (n = 106) during induction chemotherapy. IFIs were classified according to the EORTC\/MSG criteria. Results: The median age was 38.5 years, and 38.7% were female. Proven\/probable IFIs occurred in 8.9% of patients, with similar rates between the fluconazole and micafungin groups (8.7% vs. 9.4%; p = 0.82). Multivariate analysis confirmed no significant association between the prophylactic antifungal type and IFI incidence, indicating comparable outcomes across groups. The median prophylaxis duration was longer with fluconazole, while the discontinuation rates, switch patterns, and subsequent antifungal use were comparable. The overall infection rates (~60%) and distribution of bacterial, viral, and polymicrobial infections were similar between the two groups. Prior bacterial infection increased the risk of IFI by 2.7-fold, and IFI-positive patients had longer neutropenia. At the end of induction, the remission, refractory, and mortality rates were similar between groups. The median overall survival was 24 months. Conclusions: Fluconazole and micafungin showed similar efficacy as the primary antifungal prophylaxis treatment in adult ALL patients. Given the limited evidence in adults and the ongoing need to optimize antifungal strategies, prospective randomized trials directly comparing these agents in this population are needed to confirm and expand upon our findings.<\/jats:p>","DOI":"10.3390\/jcm14207294","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T11:39:34Z","timestamp":1760701174000},"page":"7294","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Real-World Outcomes of Antifungal Prophylaxis in Adult Acute Lymphoblastic Leukemia Patients: A Multicenter Comparison of the Use of Fluconazole and Micafungin"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5897-6514","authenticated-orcid":false,"given":"Unal","family":"Atas","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Akdeniz University, Antalya 07100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7129-418X","authenticated-orcid":false,"given":"Utku","family":"Iltar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Akdeniz University, Antalya 07100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orhan Kemal","family":"Yucel","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Akdeniz University, Antalya 07100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasan","family":"Salur","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Antalya City Hospital, Antalya 07080, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merve Cagla","family":"Bilek","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Akdeniz University, Antalya 07100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9307-3141","authenticated-orcid":false,"given":"Tayfun","family":"Ustabas","sequence":"additional","affiliation":[{"name":"Division of Hematology, Health Sciences University, Antalya Training and Research Hospital, Antalya 07100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ozlem","family":"Candan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Division of Hematology, Marmara University, Istanbul 34854, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gulten","family":"Korkmaz","sequence":"additional","affiliation":[{"name":"Division of Hematology, Ankara Bilkent City Hospital, Ankara 06800, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8742-3388","authenticated-orcid":false,"given":"Selin","family":"Kucukyurt","sequence":"additional","affiliation":[{"name":"Division of Hematology, Ankara Etlik City Hospital, Ankara 06170, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pinar","family":"Tiglioglu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Division of Hematology, Istanbul Medeniyet University, Istanbul 34700, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6732-8068","authenticated-orcid":false,"given":"Sureyya","family":"Yigit Kaya","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Division of Hematology, Istanbul Medipol University, Istanbul 34815, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burak","family":"Deveci","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Division of Hematology, Antalya Bilim University, Antalya 07190, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atakan","family":"Tekinalp","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Division of Hematology, Necmettin Erbakan University, Konya 42090, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5687-8531","authenticated-orcid":false,"given":"Rafiye","family":"Ciftciler","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Division of Hematology, Selcuk University, Konya 42250, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5281-5955","authenticated-orcid":false,"given":"Aysun","family":"Senturk Yikilmaz","sequence":"additional","affiliation":[{"name":"Division of Hematology, Denizli State Hospital, Denizli 20010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tayfun","family":"Elibol","sequence":"additional","affiliation":[{"name":"Division of Hematology, G\u00f6ztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul 34722, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2690-8581","authenticated-orcid":false,"given":"Tayfur","family":"Toptas","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Division of Hematology, Marmara University, Istanbul 34854, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5522-8342","authenticated-orcid":false,"given":"Ahmet Kursad","family":"Gunes","sequence":"additional","affiliation":[{"name":"Division of Hematology, Ankara Etlik City Hospital, Ankara 06170, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9636-4113","authenticated-orcid":false,"given":"Omur Gokmen","family":"Sevindik","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Division of Hematology, Istanbul Medipol University, Istanbul 34815, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2035-9462","authenticated-orcid":false,"given":"Leylagul","family":"Kaynar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Division of Hematology, Istanbul Medipol University, Istanbul 34815, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabin","family":"Saba","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Division of Hematology, Antalya Bilim University, Antalya 07190, 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Akdeniz University, Antalya 07100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erdal","family":"Kurtoglu","sequence":"additional","affiliation":[{"name":"Division of Hematology, Health Sciences University, Antalya Training and Research Hospital, Antalya 07100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9853-5075","authenticated-orcid":false,"given":"Levent","family":"Undar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Akdeniz University, Antalya 07100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1182\/blood-2014-03-560847","article-title":"Infection-related mortality in children with acute lymphoblastic leukemia: An analysis of infectious deaths on 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