{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T20:02:12Z","timestamp":1791403332805,"version":"4.3.3"},"reference-count":45,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,7,23]],"date-time":"2021-07-23T00:00:00Z","timestamp":1626998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Patients with hematologic malignancies and hematopoietic cell transplant recipients (HCT) are at high risk for invasive fungal disease (IFD). The practice of antifungal prophylaxis with mold-active azoles has been challenged recently because of drug\u2013drug interactions with novel targeted therapies. This is a retrospective, single-center cohort study of consecutive cases of proven or probable IFD, diagnosed between 2009 and 2019, in adult hematologic patients and HCT recipients managed with fluconazole prophylaxis and an antifungal diagnostic-driven approach for mold infection. During the study period, 94 cases of IFD occurred among 664 hematologic patients and 316 HCT recipients. The frequency among patients with allogeneic HCT, autologous HCT, acute leukemia and other hematologic malignancies was 8.9%, 1.6%, 17.3%, and 6.4%, respectively. Aspergillosis was the leading IFD (53.2%), followed by fusariosis (18.1%), candidiasis (10.6%), and cryptococcosis (8.5%). The overall 6-week mortality rate was 37.2%, and varied according to the host and the etiology of IFD, from 28% in aspergillosis to 52.9% in fusariosis. Although IFD occurred frequently in our cohort of patients managed with an antifungal diagnostic driven approach, mortality rates were comparable to other studies. In the face of challenges posed by the use of anti-mold prophylaxis, this strategy remains a reasonable alternative.<\/jats:p>","DOI":"10.3390\/jof7080588","type":"journal-article","created":{"date-parts":[[2021,7,23]],"date-time":"2021-07-23T04:29:14Z","timestamp":1627014554000},"page":"588","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":49,"title":["Epidemiology of Invasive Fungal Diseases in Patients with Hematologic Malignancies and Hematopoietic Cell Transplantation Recipients Managed with an Antifungal Diagnostic Driven Approach"],"prefix":"10.3390","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5795-1785","authenticated-orcid":false,"given":"Maria Daniela","family":"Bergamasco","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Hospital S\u00e3o Paulo-University Hospital, Universidade Federal de S\u00e3o Paulo, S\u00e3o Paulo 04024-002, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos Alberto P.","family":"Pereira","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Hospital S\u00e3o Paulo-University Hospital, Universidade Federal de S\u00e3o Paulo, S\u00e3o Paulo 04024-002, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celso","family":"Arrais-Rodrigues","sequence":"additional","affiliation":[{"name":"Division of Hematology, Hospital S\u00e3o Paulo-University Hospital, Universidade Federal de S\u00e3o Paulo, S\u00e3o Paulo 04024-002, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2533-4229","authenticated-orcid":false,"given":"Diogo B.","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Hospital S\u00e3o Paulo-University Hospital, Universidade Federal de S\u00e3o Paulo, S\u00e3o Paulo 04024-002, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Otavio","family":"Baiocchi","sequence":"additional","affiliation":[{"name":"Division of Hematology, Hospital S\u00e3o Paulo-University Hospital, Universidade Federal de S\u00e3o Paulo, S\u00e3o Paulo 04024-002, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Kerbauy","sequence":"additional","affiliation":[{"name":"Division of Hematology, Hospital S\u00e3o Paulo-University Hospital, Universidade Federal de S\u00e3o Paulo, S\u00e3o Paulo 04024-002, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4867-0014","authenticated-orcid":false,"given":"Marcio","family":"Nucci","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hospital Universit\u00e1rio Clementino Frafa Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0793-8491","authenticated-orcid":false,"given":"Arnaldo Lopes","family":"Colombo","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Hospital S\u00e3o Paulo-University Hospital, Universidade Federal de S\u00e3o Paulo, S\u00e3o Paulo 04024-002, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.blre.2016.09.002","article-title":"Risk stratification for invasive fungal infections in patients with hematological malignancies: SEIFEM recommendations","volume":"31","author":"Pagano","year":"2017","journal-title":"Blood Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1038\/bmt.2017.222","article-title":"Foiling fungal disease post hematopoietic cell transplant: Review of prophylactic strategies","volume":"53","author":"Rubinstein","year":"2017","journal-title":"Bone Marrow Transplant."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1016\/j.bbmt.2014.03.004","article-title":"Incidence and Outcome of Invasive Fungal Diseases after Allogeneic Stem Cell Transplantation: A Prospective Study of the Gruppo Italiano Trapianto Midollo Osseo (GITMO)","volume":"20","author":"Girmenia","year":"2014","journal-title":"Biol. 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