# Antifungal prophylaxis for people at high risk of invasive fungal infection

Source: https://onco.cc/protocols/antifungal-prophylaxis-in-haematology/  
OnCo record `antifungal-prophylaxis-in-haematology` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

People on the most intensive leukaemia treatment, or a stem cell transplant from a donor, are at risk of serious mould infections in the lungs. Most are offered a preventive antifungal medicine, usually posaconazole, while their immunity is lowest. Other cancer treatments usually do not need one. These drugs interact with many medicines, so the pharmacist checks every combination.

## Summary

Give systemic antifungal prophylaxis only to groups at high risk of invasive fungal disease, and make it mould-active. In children (POGO 2020, endorsed by COG; the 2026 update maintains these): strong recommendations for AML expected to cause profound and prolonged neutropenia (high quality) and for allogeneic HSCT pre-engraftment and during systemic immunosuppression for GVHD (moderate); consider it in newly diagnosed or relapsed ALL at high risk (weak, low); do not use it routinely in low-risk ALL or in most lymphomas and solid tumours (strong); not routinely in autologous HSCT (weak). If warranted, use a mould-active agent (strong, high), an echinocandin or a mould-active azole (strong, moderate), and not amphotericin routinely (strong, low). In adults, ECIL-10 (2025) grades posaconazole A-I during remission induction for AML and MDS, gives isavuconazole, micafungin and caspofungin B-II, does not indicate prophylaxis in ALL, Hodgkin lymphoma, myeloma or autologous HSCT, endorses mould-active prophylaxis for high-risk CAR-T recipients, and now counts children with ALL aged 12 or older or with insufficient treatment response as high risk. Mould-active azoles are not recommended with vincristine (D-II). ASCO/IDSA (2018) recommend antifungal prophylaxis for patients expected to have profound, protracted neutropenia.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: mould-active prophylaxis; mold-active prophylaxis; posaconazole prophylaxis; primary antifungal prophylaxis; azole prophylaxis; invasive aspergillosis prevention
- Tags: protocol; antimicrobial-prophylaxis; antifungal; paediatric

## Connected records

- protocols: [Antibacterial (fluoroquinolone) prophylaxis during expected severe neutropenia](https://onco.cc/protocols/antibacterial-prophylaxis-in-neutropenia/), [Fever and neutropenia in children with cancer or after stem cell transplant](https://onco.cc/protocols/paediatric-fever-and-neutropenia/), [Protective measures and daily life during neutropenia: hand hygiene, visitors, pets, plants, school and swimming](https://onco.cc/protocols/neutropenic-precautions-and-daily-life/)
- drugs: [Venetoclax](https://onco.cc/drugs/venetoclax/), [Vincristine](https://onco.cc/drugs/vincristine/)
- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [Acute myeloid leukaemia](https://onco.cc/cancers/aml/), [Childhood cancers (all types)](https://onco.cc/cancers/childhood-cancers/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Allogeneic stem cell transplantation](https://onco.cc/technologies/allogeneic-hsct/), [Autologous stem cell transplant (high-dose therapy)](https://onco.cc/technologies/autologous-stem-cell-transplant/), [CAR-T cell therapy](https://onco.cc/technologies/car-t/)
- companies: [Children's Oncology Group (COG)](https://onco.cc/companies/childrens-oncology-group/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/)
- terms: [Infection prophylaxis in lymphoma: PJP, herpes, fungal risk and vaccination](https://onco.cc/terms/lymphoma-tx-pjp-and-infection-prophylaxis/), [Neutropenia](https://onco.cc/terms/neutropenia/)

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