Annals of Hematology

, Volume 93, Issue 9, pp 1449–1456 | Cite as

Primary prophylaxis of invasive fungal infections in patients with haematologic malignancies. 2014 update of the recommendations of the Infectious Diseases Working Party of the German Society for Haematology and Oncology

  • Daniela Tacke
  • Dieter Buchheidt
  • Meinolf Karthaus
  • Stefan W. Krause
  • Georg Maschmeyer
  • Silke Neumann
  • Helmut Ostermann
  • Olaf Penack
  • Christina Rieger
  • Markus Ruhnke
  • Michael Sandherr
  • Katharina E. Schweer
  • Andrew J. Ullmann
  • Oliver A. CornelyEmail author
Review Article


Invasive fungal infections cause substantial morbidity and mortality in immunocompromised patients, particularly in those with haematological malignancies and recipients of allogeneic haematopoietic stem cell transplantation. Difficulties in diagnosing invasive fungal infections and subsequent delays in treatment initiation lead to unfavourable outcomes and emphasise the importance of prophylaxis. Since the recommendations of the Infectious Diseases Working Party of the German Society for Haematology and Oncology in 2009, results of 14 additional clinical studies have been published comprising 2,899 patients and initiating this update. Key recommendations for adult patients are as follows: Posaconazole remains the drug of choice during remission-induction chemotherapy in acute myeloid leukaemia, myelodysplastic syndrome and allogeneic haematopoietic stem cell transplantation with graft versus host disease (AI). In the pre-engraftment period of allogeneic transplantation, several antifungals are appropriate and can be recommended with equal strength: voriconazole (BI), micafungin (BI), fluconazole (BI) and posaconazole (BII). There is poor evidence regarding antifungal prophylaxis in the post-engraftment period of allogeneic haematopoietic stem cell transplantation if no steroids for treatment of graft versus host disease are required. Aerosolised liposomal amphotericin B inhalation in conjunction with fluconazole can be used in patients with prolonged neutropenia (BII).


Invasive fungal infection Antifungal prophylaxis Itraconazole Fluconazole Posaconazole Amphotericin B Liposomal 


Conflict of interest

Dr. Tacke reports personal fees from MSD, personal fees from Gilead Sciences GmbH, peronal fees from Pfizer and personal fees from Astellas, outside the submitted work. Dr. Tacke is affiliated to the COMBACTE consortium. She has received support from the Innovative Medicines Initiative Joint Undertaking under grant agreement no. 115523; resources of which are composed of financial contribution from the European Union’s Seventh Framework Programme (FP7/2007-2013) and EFPIA companies in kind contribution.

Dr. Buchheidt reports grants and personal fees from Gilead Sciences, grants and personal fees from Pfizer, personal fees and non-financial support from Astellas, personal fees and non-financial support from Merck Sharp & Dohme/Merck, outside the submitted work.

Dr. Karthaus reports personal fees from MSD, personal fees from Astellas and personal fees from Pfizer, outside the submitted work.

Dr. Krause reports personal fees from MSD and personal fees from Gilead, outside the submitted work.

Dr. Maschmeyer reports personal fees from Gilead, personal fees from Pfizer and personal fees from MSD, outside the submitted work.

Dr. Neumann reports personal fees from Gilead and personal fees from MDS, outside the submitted work.

Dr. Ostermann reports grants and personal fees from MSD, grants and personal fees from Gilead and personal fees from Astellas, outside the submitted work.

Dr. Penack reports personal fees from MSD, personal fees from Astellas, personal fees from Gilead and grants from Pfizer, outside the submitted work.

Dr. Rieger has nothing to disclose.

Dr. Ruhnke reports grants from commercial sponsor (Pfizer, Roche Molecular Diagnostics) and personal fees from commercial sponsor (Astellas, Gilead, Pfizer), outside the submitted work.

Dr. Sandherr has nothing to disclose.

Dr. Schweer has nothing to disclose.

Dr. Ullmann reports grants and personal fees from MSD, personal fees from Gilead, personal fees from Pfizer and personal fees from Astellas, outside the submitted work.

Dr. Cornely is supported by the German Federal Ministry of Research and Education (BMBF grant 01KN1106); received research grants from 3 M, Actelion, Astellas, Basilea, Bayer, Celgene, Cubist, F2G, Genzyme, Gilead, GSK, Merck/MSD, Miltenyi, Optimer, Pfizer, Quintiles and Viropharma; a consultant to 3 M, Astellas, Basilea, Cubist, F2G, Gilead, GSK, Merck/MSD, Optimer, Pfizer, Sanofi Pasteur and Summit/Vifor; and received lecture honoraria from Astellas, Gilead, Merck/MSD and Pfizer.

Supplementary material

277_2014_2108_MOESM1_ESM.docx (248 kb)
ESM 1 (DOCX 687 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Daniela Tacke
    • 1
    • 14
    • 17
  • Dieter Buchheidt
    • 2
  • Meinolf Karthaus
    • 3
  • Stefan W. Krause
    • 4
  • Georg Maschmeyer
    • 5
  • Silke Neumann
    • 6
  • Helmut Ostermann
    • 7
  • Olaf Penack
    • 8
  • Christina Rieger
    • 7
  • Markus Ruhnke
    • 9
  • Michael Sandherr
    • 10
  • Katharina E. Schweer
    • 1
    • 14
    • 17
  • Andrew J. Ullmann
    • 11
  • Oliver A. Cornely
    • 1
    • 12
    • 13
    • 14
    • 15
    • 16
    Email author
  1. 1.Klinik I für Innere MedizinUniklinik KölnKölnGermany
  2. 2.III. Medizinische KlinikUniversitätsmedizin MannheimMannheimGermany
  3. 3.Klinik für Hämatologie und OnkologieKlinikum NeuperlachMünchenGermany
  4. 4.Hämatologie und Internistische OnkologieUniversitätsklinikum ErlangenErlangenGermany
  5. 5.Klinik für Hämatologie, Onkologie und PalliativmedizinErnst von Bergmann KlinikumPotsdamGermany
  6. 6.Ambulantes OnkologiezentrumWolfsburgGermany
  7. 7.Medizinische Klinik und Poliklinik IIIKlinikum der Universität MünchenMünchenGermany
  8. 8.Medizinische Klinik m.S. Hämatologie, Onkologie und TumorimmunologieCharité-Universitätsmedizin Berlin Campus Virchow-KlinikumBerlinGermany
  9. 9.Medizinische Klinik und Poliklinik mit Schwerpunkt Onkologie und Hämatologie, Charité-Universitätsmedizin Berlin, Campus Mitte BerlinBerlinGermany
  10. 10.Schwerpunktpraxis für Hämatologie und OnkologieWeilheimGermany
  11. 11.Medizinische Klinik und Poliklinik II-Schwerpunkt InfektiologieUniversitätsklinikum WürzburgWürzburgGermany
  12. 12.Zentrum für Klinische Studien (BMBF 01KN1106)Medical Fuculty, University of CologneCologneGermany
  13. 13.CECAD – Cologne Excellence Cluster on Cellular Stress Responses in Aging–Associated DiseasesMedical Faculty, University of CologneCologneGermany
  14. 14.Center for Integrated Oncology CIO Köln-Bonn, Medical FacultyUniversity of CologneCologneGermany
  15. 15.German Centre for Infection Research (DZIF), partner site Bonn-CologneCologneGermany
  16. 16.CHIR-Net, Chirurgisches Regionalzentrum Witten/Herdecke—KölnUniversität Witten/Herdecke gGmbH/Universität KölnCologneGermany
  17. 17.COMBACTE-consortium

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