CELL INTELLIGENCE · 肿瘤细胞治疗研究

Invasive fungal diseases (IFDs) remain a significant cause of morbidity and mortality among patients with hematological malignancies, especially those undergoing intensive chemotherapy or hematopoietic stem cell transplantation (HSCT). This text provides a comprehensive risk-adapted framework for antifungal prophylaxis, stratifying patients into high-, intermediate-, and low-risk categories. Mold-active prophylaxis, primarily with posaconazole, is recommended for high-risk patients such as those with acute myeloid leukemia during remission induction or those with grade III-IV graft-versus-host disease following allogeneic HSCT.

Fluconazole remains an option for yeast-active prophylaxis in intermediate-risk patients, while low-risk groups generally do not require prophylaxis. The evolving landscape of targeted therapies such as venetoclax, FMS-like tyrosine kinase 3 inhibitors, and CD19 chimeric antigen receptor T-cell (CAR-T) therapy poses new challenges, particularly due to drug-drug interactions with triazole antifungals. In patients receiving venetoclax, azole co-administration necessitates significant dose adjustments.

We also present algorithms for antifungal management in the context of CD19 CAR-T therapy and novel agents, emphasizing the role of individualized risk assessment. Beyond prophylaxis, timely diagnosis and early treatment of IFDs are critical. The role of thoracic computed tomography, serum and bronchoalveolar lavage galactomannan, and fungal biomarkers is discussed within diagnostic-driven strategies.

We outline treatment pathways for suspected pulmonary or sinus fungal infections, including when to escalate antifungal therapy or consider surgical intervention. This content offers a practical and evidence-based guide for clinicians navigating antifungal strategies in a rapidly changing therapeutic landscape, aiming to reduce IFD-related mortality while balancing toxicity, resistance, and healthcare costs. Hematolojik maligniteli hastalarda invaziv fungal enfeksiyonlar (IFE), zellikle yo un kemoterapi veya hematopoietik k k h cre nakli (HKHN) alan hastalarda morbidite ve mortalitenin nde gelen nedenlerinden biridir. Bu derlemede, hastalar n IFE riski do rultusunda y ksek, orta ve d k risk gruplar na ayr ld kapsaml bir antifungal profilaksi yakla m sunulmu tur. Akut miyeloid l semi ind ksiyon tedavisi alanlar ve allojenik HKHN sonras derece III-IV graft-versus-host hastal geli en hastalarda posakonazol ile k f-aktif profilaksi nerilmektedir. Orta riskli hastalar i in flukonazol ile maya-aktif profilaksi uygunken, d k riskli gruplar genellikle profilaksiye ihtiya duymaz.

Hedefe y nelik ajanlar n ( rne in; venetoklaks, FMS-like tirozin kinaz 3 inhibit rleri, CD19 kimerik antijen resept r T-h cre [CAR-T] tedavisi) kullan m , azollerin ila -ila etkile imleri nedeniyle yeni zorluklar do urmu tur. Venetoklaks alan hastalarda e zamanl azol kullan m doz ayarlamas gerektirir. Ayr ca, CAR-T tedavisi veya yeni nesil tedaviler s ras nda antifungal tedavi y netim algoritmalar sunulmu tur. Tan sal yakla mlarda toraks bilgisayarl tomografi, serum/bronkoalveolar lavaj galaktomannan ve mantar biyobelirte lerinin yeri vurgulanm t r.

pheli akci er veya sin s mantar enfeksiyonlar i in tedavi yollar n zetliyoruz; bunlar aras nda antifungal tedavinin ne zaman art r lmas veya cerrahi m dahalenin ne zaman d n lmesi gerekti i de yer almaktad r. Bu yaz , h zla de i en tedavi ortam nda antifungal stratejilerde yol g steren klinisyenler i in pratik ve kan ta dayal bir k lavuz sunarak, toksisite, diren ve sa l k hizmetleri maliyetlerini dengeleyerek IFE ile ilgili mortaliteyi azaltmay ama lamaktad r.