在目前抗真菌预防时代，我们对于急性髓系白血病（AML）中持续发热性中性粒细胞减少症（FN）常规经验性抗真菌治疗的必要性进行了批判性重新评估，并比较了接受经验性或预防性抗真菌治疗的患者的临床结果。我们回顾性地研究了单个中心于2016年9月至2020年12月间接受诱导或再诱导化疗，且在抗真菌预防期间发展出FN持续≥4天的成年AML患者（年龄≥18岁）。根据抗真菌治疗开始时是否存在侵袭性真菌感染（IFI）的临床证据，将患者分为预防性组和经验性组，分别接受预防性或经验性抗真菌治疗。在倾向性评分匹配（PSM）后比较了两组的临床结果。共分析了229个化疗周期（经验性组36个，预防性组193个）。在预防性组中，有45个（23.3%）周期接受了广谱抗真菌治疗。在1:3 PSM后，经验性和预防性组在经过证实或可能IFI的发生率（0/36 [0%] vs. 5/97 [5.2%]，p = 0.323）、全因死亡率（3/36 [8.3%] vs. 4/97 [4.1%]，p = 0.388）和IFI相关死亡率（0/36 [0.0%] vs. 1/45 [2.2%]，p = 0.556）方面没有显著差异。在接受抗真菌预防的AML患者中，经验性和预防性抗真菌治疗的临床结果差异在统计学上没有显著意义。因此，在出现IFI明确证据之前，可以延迟给予接受抗真菌预防的患者广谱抗真菌治疗。版权所有 © 2023 Elsevier Ltd.

To critically re-evaluate the necessity of routine empirical antifungal therapy in prolonged febrile neutropenia (FN) in acute myelogenous leukemia (AML) in the current era of antimold prophylaxis, we compared clinical outcomes in such patients who were treated with either empirical or preemptive antifungal therapy.We retrospectively reviewed adult AML patients (aged ≥ 18 years) who received antimold prophylaxis and developed FN for ≥ 4 days during induction or re-induction chemotherapy at a single center between September 2016 and December 2020. Patients were categorized into preemptive or empirical groups based on whether there was clinical evidence of invasive fungal infection (IFI) at the start of antifungal treatment or not, respectively. Clinical outcomes were compared between the two groups after propensity score matching (PSM).In total, 229 chemotherapy episodes (36 and 193 in the empirical and preemptive groups, respectively) were analyzed. In the preemptive group, broad-spectrum antifungal therapy was administered in 45 (23.3%) episodes. After 1:3 PSM, there were no significant differences between empirical and preemptive groups in terms of the incidence of proven or probable IFIs (0/36 [0%] vs. 5/97 [5.2%], p = 0.323), all-cause mortality (3/36 [8.3%] vs. 4/97 [4.1%], p = 0.388), or IFI-related mortality (0/36 [0.0%] vs. 1/45 [2.2%], p = 0.556).The differences in clinical outcomes were statistically not significant between empirical and preemptive antifungal therapy in patients with AML who received antimold prophylaxis. Therefore, broad-spectrum antifungal therapy in patients receiving antimold prophylaxis might be delayed until there is clear evidence of IFIs.Copyright © 2023. Published by Elsevier Ltd.