1. Antimicrobial Prophylaxis for Hematologic Malignancies
Disease/Treatment
Fungal
Viral
PCP
Duration
AML
Voriconazole
Acyclovir -
Fungal- During neutropenia (beginning day 4 of induction)
Viral- All treatment cycles
ALL
Bactrim
Fungal- During neutropenia
Viral/PCP- All treatment cycles
Aplastic Anemia/MDS
Acyclovir- during neutropenia/treatment
Fungal- during prolonged neutropenia
Proteosome Inhibitors (i.e. bortezomib, carfilzomib, ixazomib)
During treatment
High-dose steroids (i.e. dexamethasone 40 mg weekly)
Purine Analogs (i.e cladribine, fludarabine, nelarabine, pentostatin, bendamustine)
2 months after completion of treatment
Hyper-CVAD (for lymphoma)
Fluconazole
Viral/PCP- During treatment
R-da-EPOCH
PI3K inhibitors (i.e. idelalisib or copanlisib)
During Treatment
Intensified/Salvage Chemo for Lymphoma (i.e. CHOEP, DHAP, GDP, ESHAP, ICE, maxi-CHOP/Nordic regimen, BEACOPP)

2. - Voriconazole 200 mg PO BID
Preferred Regimen
Alternative Regimen
Comments
Fungal
- Voriconazole 200 mg PO BID
- Fluconazole 200mg PO daily (when mold prophylaxis not indicated)
- Micafungin 50 mg IV daily
- Fluconazole 200 mg PO daily
- Hold voriconazole 2 days before and 4 days after vincristine
- Do not give voriconazole with TKIs (Ph+ ALL); caution with FLT3 inhibitors
- Reduce venetoclax dose by 75% with voriconazole
- If visual sxs, consider 25% dose reduction
Viral
- Acyclovir 400 mg PO BID -
PCP
TMP/SMX
- 1 SS tab daily OR
- 1 DS tab 3x per week
- Dapsone 100 mg PO daily (preferred) OR
- Atovaquone 1,500 mg PO daily
- Hold TMP/SMX for high-dose methotrexate
- Check G6PD prior to dapsone use
Testing
Notes
Treatment
HBV
- sAg, sAb, cAb total
- If sAg or cAb pos, then HBV DNA (q3 month)
Treat if sAg or HBV DNA positive
AND
Chemo, steroids, or anti-CD20
- Entecavir 0.5 mg PO daily OR
- Tenofovir 300 mg PO daily
Latent TB
- IGRA (annual)
- Screen for active TB (CXR, symptoms) and order TB rule out if indicated
- Do not start LTB treatment until AFB cultures final
- B6 and monthly LFTs w/ INH
- Rifampin 600 mg PO daily x4 months OR
- INH 300 mg PO daily x 9 months OR
- INH 900 mg PO weekly with Rifapentine 900 mg PO weekly x12 weeks
HIV
HIV 1/2 ab
Confirm with viral load, CD4 count
Refer to ID
HCV
HCV ab
Confirm with viral load and genotype
Refer for HCV treatment