Invasive fungal disease (IFD) is one of the life-threatening infectious complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Major fungal species are
Candida and
Aspergillus. Candidiasis mainly develops in the early post-transplant period with neutropenia and mucositis, while Asperigillosis both in the early and later periods. Protective environment effectively prevents aspergillosis and is recommended in the early post-transplant period. Therefore, in the setting of HSCT in protective environment, early-post transplant prophylaxis of IFD should focus mainly on candidiasis. In the later period when acute and chronic graft-versus-host disease develop and the exposure of systemic glucocorticoid would increase the risk of IFD, prophylaxis should focus on aspergillosis. Evidences based on the studies having evaluated the efficacy and safety of several anti-fungal agents in the prophylaxis of IFD after allo-HSCT have been accumulated. In this review, the results of studies of each anti-fungal agent were summarized, and the current status and limitation of prophylaxis of IFD after allo-HSCT in Japan were discussed.
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