Combination antifungal therapy for invasive mould diseases in haematologic patients. An update on clinical data

Invasive mould diseases (IMDs) are often encountered in haematologic patients who undergo chemotherapy or who require allogeneic haematopoietic stem cell transplantation (allo-HSCT) and still represent a challenge for physicians. The availability of antifungals with different targets has set the foundation to improve the outcomes of patients with IMDs and also to develop innovative therapeutic approaches. Among these using combinations of antifungal drugs is an attractive option for reasons such as the broader spectrum of activity synergy between compounds with different targets and a reduced risk of fungal resistance. In addition in vitro studies and animal models have provided evidence supporting the use of combination strategies. Although no controlled well-powered prospective clinical trials are yet available to demonstrate the superiority of combination versus monotherapy the persistently high mortality rate associated with IMDs has stimulated the use of combinations of antifungal drugs both in adult and paediatric patients. In this paper we review the recent published literature on combination therapy for the treatment of IMDs in adult and paediatric haematologic patients.