Table 6.

Proposed guidelines for antifungal prophylaxis during VEN-HMA therapy

For patients with newly diagnosed AML treated with VEN-HMAs, no clear benefit from administering antifungal prophylaxis was observed for all patients

For patients who are expected to have lower response to VEN-HMAs, such as those with adverse-risk genetics, antifungal prophylaxis should be strongly considered

If the decision is made to administer antifungal prophylaxis, no class of antifungal had an advantage over another

Micafungin is an acceptable choice that can allow administration of venetoclax without dose modification

Limited data support administering azoles with appropriate venetoclax dose reduction without impacting AML response

For de novo AML patients who achieve CR with neutrophil recovery, the benefit of continuing antifungal prophylaxis during postremission cycles remains debatable

Although our data did not show a clear benefit of antifungal prophylaxis for patients with r/r AML treated with VEN-HMAs, who are at a higher risk for IFIs, based on their higher risk we recommend antifungal prophylaxis, particularly for the following subsets:

Patients with lower likelihood of response due to adverse risk genetics

Early post-alloHCT relapse

Secondary prophylaxis for patients with history of IFIs