Practices of Antifungal Prophylaxis Among Italian Pediatric Oncology-Hematology Centers.

BACKGROUND: IFD is a significant cause of illness and death among pediatric patients undergoing chemotherapy or HSCT. Application of AFP in children varies widely and is frequently off-label. This survey aims to describe real-world AFP practices across centers within AIEOP and provide an estimate of IFD incidence. METHODS: In the second half of 2023, AIEOP centers participated in a web-based questionnaire collecting data on their AFP practices, antifungal agents, and IFD cases from 2021 to 2022. RESULTS: Nineteen out of 44 AIEOP centers (43%) responded. AFP practices varied based on underlying disease and associated risk of IFD: it was used in 100% of centers treating AML, ALL-Rel, and allo-HSCT recipients, in 94.5% of centers for ALL-HR patients, and in 53% of centers with ALL-IR. Usage of AFP was limited (11%-35%) in low-risk patients (ALL-SR, HL, solid tumors). The most frequently used agents were liposomal amphotericin B and posaconazole for high-risk patients, and fluconazole for lower-risk patients. The estimated incidence of IFD was 4.7% (> 10% in ALL-Rel, NHL, allo-HSCT, SAA/AA). CONCLUSIONS: This survey shows variability in AFP drug choice. IFD rates remain elevated in high-risk groups. These results underline the need for updated, pediatric-specific national guidelines and antifungal stewardship to improve prophylaxis strategies. TRIAL REGISTRATION: The authors have confirmed clinical trial registration is not needed for this submission.