Do you routinely offer fungal prophylaxis for patients on BTK inhibitors?

We do not use antifungal prophylaxis for patients on BTK inhibitors. The risk of invasive fungal infection in patients treated with BTK inhibitors in recent large single institutional series have been 2 to 3%, without routine antifungal prophylaxis. The risk of fungal infection increases in patients...

I do not routinely prophylaxis for fungal infections with BTK inhibitors. While fungal infections, specifically aspergillus is a risk, it is still relatively rare. As well, antifungal medications often interact with BTKi.

I never use fungal prophylaxis with BTKi unless patients are on steroids. Here the risk is higher and I would consider this. There was not an increased risk of fungal pneumonia in the ELEVATE-RR over what would be expected in the CLL patient population.