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Escalating prophylaxis-Shanghai Jiao Tong University School of Medicine-invasive fungal disease refers to a risk-adapted antifungal treatment protocol developed for patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). This strategy, evaluated in a Phase 2 clinical trial (NCT02644330), involves the sequential use of antifungal agents based on the patient's transplant type and clinical status. The regimen typically begins with fluconazole during the initial hospitalization phase in laminar air flow units. For high-risk patients—such as those receiving haplo-identical or HLA-matched unrelated donor transplants—or those who develop acute graft-versus-host disease (aGVHD), the prophylaxis is escalated to broader-spectrum anti-mold agents. The primary therapeutic goal is the prevention of invasive fungal diseases (IFD) by inhibiting fungal lanosterol 14-alpha demethylase (CYP51), an enzyme essential for ergosterol synthesis and fungal cell membrane integrity.
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