Defining Invasive Fungal Infection Risk in Hematological Malignancies: A New Tool for Clinical Practice

Defining invasive fungal infection risk in hematological malignancies: a new tool for clinical practice. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Dear Editor, Invasive fungal infections (IFIs) represent an important cause of morbidity and mortality in patients affected by hematological malignancies (HMs), particularly those with an immunocompromised status. 1,2 In this setting, IFIs still represents a major clinical problem also for the high costs related to the antifungal prophylaxis and treatment. 3,4 When considering the high clinical heterogeneity of these patients, the risk of IFIs may be remarkably different. Accordingly, if such a risk is not appropriately evaluated, the possibility of an overtreatment in some or an undertreatment in other patients is very likely. Pagano et al., on behalf of SEIFEM (Sorveglianza Epidemiologica Infezioni Fungine nelle Emopatie Maligne) group, recently published a systematic review of the literature on the risk and incidence of IFIs in the setting of HMs with the aim to consider the main predisposing factors and to suggest practical strategies for prevention and treatment of IFIs. 5 In this review, specific IFI predisposing factors are summarized for each disease class. Depending on the risk of developing IFIs, patients are then divided into three groups: high, intermediate, low-risk group. Briefly, patients with acute myeloid leukemia (AML) or treated with an allogeneic hematopoietic stem cell transplantation (HSCT) have per se an increased risk of IFI. Moreover, some conditions predispose a high risk of IFI, independently of the underlying disease, like neutropenia, relapse/refractory disease, previous history of IFI, salvage therapy and a high dose of steroids. To facilitate the reading of this analysis and to estimate in each patient the IFI specific risk, we here propose a practical consultation tool composed of a table where risk categories, their related risk factors, and the HMs, are reported and matched (Table 1, part 1 and 2). This estimated risk stratification was developed correlating each disease class with the variables risk factors, categorized according to patient's features, underlying comorbidities, immunity status, environmental factors, neutropenic status, disease and therapy or transplant's procedures. By this approach, each box of the table represents a matching of a specific disease with a specific risk factor. Red boxes, expressing a high risk (HR) of IFI, are used to indicate a reported …