New hematologic populations at risk of invasive aspergillosis: focus on new targeted, biological, and cellular therapies

The introduction of new targeted, biological, and cellular therapies in patients with hematologic malignancies has improved the outcomes of patients but in parallel has changed the frequency and epidemiology of infections, including invasive aspergillosis (IA). In this article, recent literature on the epidemiology and clinical findings of IA in patients who have lymphoproliferative and myeloproliferative diseases and are undergoing novel targeted treatment with kinase inhibitors, agents targeting cell surface antigens, chimeric antigen receptor-modified T cells, and antibodies to immune checkpoint molecules is reviewed and the clinical impact of IA on the overall management of the underlying disease is discussed. Overall, IA represents a variable and uncommon complication in these populations, but given the increasing eligibility criteria of these novel treatments (particularly in patients with relapsed or refractory hematologic malignancies) and the prolonged periods of therapy, a considerable number of unusual cases of Aspergillus infections can be expected in clinical practice.