Although the widespread use of mold-active agents (especially the new generation of triazoles) has resulted in reductions of documented invasive mold infections (IMIs) in patients with hematological malignancies and allogeneic hematopoietic stem cell transplantation (HSCT), a subset of such patients still develop breakthrough IMIs (bIMIs). There are no data from prospective randomized clinical trials to guide therapeutic decisions in the different scenarios of bIMIs. In this viewpoint, we present the current status of our understanding of the clinical, diagnostic, and treatment challenges of bIMIs in high-risk adult patients with hematological cancer and/or HSCT receiving mold-active antifungals and outline common clinical scenarios. As a rule, managing bIMIs demands an individualized treatment plan that takes into account the host, including comorbidities, certainty of diagnosis and site of bIMIs, local epidemiology, considerations for fungal resistance, and antifungal pharmacological properties. Finally, we highlight areas that require future investigation in this complex area of clinical mycology.

中文翻译：

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血液病患者侵袭性霉菌感染的突破：当前概念和未来方向


尽管霉菌活性剂（尤其是新一代三唑类）的广泛使用已导致血液恶性肿瘤和异基因造血干细胞移植（HSCT）患者中记录的侵袭性霉菌感染（IMIs）减少，但此类患者中的一部分仍然开发突破性 IMI（bIMIs）。目前尚无前瞻性随机临床试验数据来指导不同 bIMIs 情况下的治疗决策。从这个角度来看，我们介绍了我们对接受霉菌活性抗真菌药物的血液癌和/或 HSCT 高危成年患者的 bIMIs 的临床、诊断和治疗挑战的理解现状，并概述了常见的临床情况。一般来说，管理 bIMIs 需要一个考虑到宿主的个体化治疗计划，包括合并症、诊断的确定性和 bIMIs 部位、当地流行病学、真菌耐药性的考虑因素以及抗真菌药理学特性。最后，我们强调了临床真菌学这一复杂领域未来需要研究的领域。