Fungal Infection Risk in Cancer Patients

High-Risk Hematological Malignancies

The National Comprehensive Cancer Network recommends that patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) receiving intensive chemotherapy are at high risk for invasive fungal infections due to prolonged profound neutropenia (>10 days with counts <100/mcL) 2, 3, 4
Allogeneic hematopoietic stem cell transplant (HSCT) recipients, especially those with graft-versus-host disease (GVHD) requiring corticosteroids, are at high risk for invasive fungal infections 2, 4
Acute lymphoblastic leukemia (ALL) in adults undergoing intensive chemotherapy is at high risk for invasive fungal infections, though pediatric ALL carries low risk except for Pneumocystis pneumonia 3, 5
Refractory or relapsed hematological malignancies after multiple lines of therapy are at high risk for invasive fungal infections, with nearly 90% of heavily pretreated fludarabine-refractory CLL patients experiencing serious infectious complications 1

Chronic lymphocytic leukemia (CLL) has low baseline risk but becomes high-risk with BTK inhibitor therapy (ibrutinib), with IFD incidence of 2-3% 4
Multiple myeloma shows a biphasic infection pattern—early Streptococcus pneumoniae and Haemophilus influenzae infections, but fungal risk increases with advanced disease, neutropenia, and high-dose corticosteroids 1, 4
Non-Hodgkin's lymphoma risk varies by treatment intensity and immunosuppression 1
Hodgkin lymphoma carries low risk (0.5% IFD incidence), and routine antifungal prophylaxis is not recommended 4

Prolonged neutropenia (>10 days, especially <100/mcL) is a critical risk factor for invasive fungal infections 2, 3, 4
High-dose corticosteroids (>0.3 mg/kg/day for >60 days) increase the risk of invasive fungal infections 2, 5
T-cell immunosuppressants (cyclosporine, TNF-α blockers, monoclonal antibodies, nucleotide analogues within 90 days) increase the risk of invasive fungal infections 2, 5
Total body irradiation causing gastrointestinal damage increases the risk of invasive fungal infections 3, 5
Fludarabine with prolonged immunosuppressive effects (months on lymphopoiesis) increases the risk of invasive fungal infections 3, 5
Prior invasive fungal disease is a host factor that increases the risk of invasive fungal infections 3, 5
Advanced/refractory malignancy status is a host factor that increases the risk of invasive fungal infections 1, 5
Malnutrition is a host factor that increases the risk of invasive fungal infections 1
Organ dysfunction is a host factor that increases the risk of invasive fungal infections 2