Editor’s Note: Bringing together leading experts in the field, the 14th Lu Daopei Hematology Forum opened on August 21, 2026, at Hebei Yanda Lu Daopei Hospital. Building on 14 years of academic development, this year’s conference focused on cutting-edge topics including hematopoietic stem cell transplantation, cellular immunotherapy, and precision diagnosis and treatment of hematologic disorders. The conference brought together leading experts and scholars from across China to discuss the future development of hematology and served as an important platform for advancing the diagnosis and treatment of hematologic diseases in China. During the conference, Oncology Frontier – Hematology Frontier invited Professor Huili Zhu from Lu Daopei Hospital to share her insights into the updated 7th edition of the guidelines for invasive fungal disease (IFD) in patients with hematologic disorders, focusing on the background of the update, key changes, and strategies for clinical implementation.Oncology Frontier – Hematology Frontier: Could you briefly introduce the background and key contents of the 7th edition of the guidelines? What major clinical challenges does this update aim to address?
Professor Huili Zhu: The current revision primarily targets patients with hematologic malignancies, including those receiving chemotherapy and hematopoietic stem cell transplantation. These patients commonly have compromised immune function. In addition, some medical institutions have limited inpatient facilities, lack laminar-flow rooms, or are located in environments with construction activities and other risk factors that may further increase the risk of IFD. Against this clinical background, China initiated the revision of the 7th edition of the guidelines.
The key updates cover four major areas. First, the guidelines establish criteria for stratifying patients at high risk of IFD. Second, they standardize prevention strategies for populations at high risk of IFD. Third, they clarify treatment strategies for breakthrough IFD occurring during prophylaxis. Fourth, they further refine the treatment pathway for confirmed IFD.
The overarching goal of the updated guidelines is to help patients safely navigate the period of fungal infection and prevent infection-related complications from adversely affecting their overall prognosis.
Oncology Frontier – Hematology Frontier: Compared with previous editions, what are the key changes in infection prevention, etiologic diagnosis, and antifungal treatment? How will these changes affect clinical decision-making?
Professor Huili Zhu: The new edition provides systematic refinements and updates across the entire IFD management pathway, with three major changes.
First, the management pathway is clearer. The guidelines systematically outline the complete diagnostic and treatment pathway, including primary prophylaxis, secondary prophylaxis, empirical therapy, pre-emptive therapy, and targeted therapy, with detailed recommendations regarding the principles for initiating each stage and the corresponding treatment strategies. This makes the guidelines more practical and easier to implement in clinical practice.
Second, diagnostic approaches have been further expanded. In terms of imaging, the new edition introduces recommendations for angiography and PET/CT, which may provide valuable diagnostic information for occult or disseminated fungal infections. For microbiological testing, the guidelines clarify the application and diagnostic thresholds for the G test, GM test, polymerase chain reaction (PCR), and metagenomic next-generation sequencing (mNGS), providing clinicians with clearer reference standards for determining IFD.
Third, treatment strategies have been further refined. For clinical scenarios such as breakthrough infections occurring after previous antifungal therapy and suspected IFD, the guidelines provide more detailed pathways for empirical, pre-emptive, and targeted treatment.
These updates are expected to optimize clinical decision-making in several ways: improving the accuracy of IFD diagnosis, shortening the time required to establish a diagnosis, and facilitating earlier initiation of standardized treatment. Ultimately, these measures may improve overall survival, reduce mortality and treatment-related adverse events, shorten hospital stays, and alleviate the economic burden on patients.
Oncology Frontier – Hematology Frontier: Guideline implementation faces real-world challenges, including individual patient differences, changes in pathogen profiles, and antifungal resistance. How can clinicians balance evidence-based recommendations with practical clinical needs in the future?
Professor Huili Zhu: The 7th edition of the guidelines has already taken into account changes in the spectrum of fungal pathogens. Compared with a decade ago, the pathogen profile of IFD in China has changed considerably since 2020. Aspergillus and Candida remain the predominant pathogens, while the incidence of Mucorales infections has been increasing.
In clinical practice, physicians can leverage emerging diagnostic technologies to improve diagnostic precision, including mNGS, PCR, and angiography. PET/CT can also be considered when clinically necessary, enabling earlier diagnosis and treatment.
Because of its relatively high cost, PET/CT is currently not recommended as a routine screening tool. In contrast, mNGS is relatively accessible and generally well accepted by patients. It is particularly valuable for the rapid diagnosis of Mucorales infections, helping shorten the diagnostic process and potentially improve patient outcomes. It has therefore already been increasingly adopted in clinical practice.
Expert Profile
Professor Huili Zhu
Lu Daopei Hospital
Deputy Chief Physician, Department of Hematopoietic Stem Cell Transplantation
Professor Huili Zhu graduated from the Pediatric Hematology program at Shengjing Hospital of China Medical University in July 2010. She subsequently joined Beijing Daopei Hospital, where she worked in pediatric hematologic chemotherapy. Since September 2012, she has worked at Hebei Yanda Lu Daopei Hospital and, since 2018, has simultaneously worked at Beijing Lu Daopei Hospital, focusing on pediatric hematology and hematopoietic stem cell transplantation.
Her clinical work focuses primarily on hematopoietic stem cell transplantation for childhood leukemia, particularly refractory and relapsed acute leukemia, as well as aplastic anemia, including Fanconi anemia and dyskeratosis congenita, and myelodysplastic syndromes. She is also involved in the management of transplant-related complications. The youngest patient she has treated was 9 months old and successfully achieved engraftment and discharge from the transplant isolation unit.
During her postgraduate training, she published a case report in the Chinese Journal of Hematology. During her clinical career, she has published articles in the Chinese Journal of Pediatric Hematology and Oncology and the Journal of Clinical Hematology. She has also participated in the EBMT and EHA annual meetings on multiple occasions, including presenting poster abstracts.
