The Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology, known by its German acronym AGIHO, is marking its thirtieth anniversary this year with a retrospective published in the Annals of Hematology that charts three decades of transformation in how infections are prevented, diagnosed and treated in patients with cancer. Established in 1996 as one of the subgroups of the DGHO, the working party has grown from a small group of German investigators into one of the society’s largest and most active bodies, now integrating colleagues from Austria and Switzerland and influencing clinical practice far beyond the German-speaking world. The anniversary review, authored by a large team led by Oliver A. Cornely and Christina T. Rieger, documents how a voluntary collaboration of physicians evolved into a global reference point for evidence-based guidance on infections in hematology and oncology.
The origins of the group lie in the multicenter studies on antimicrobial therapy in acute leukemia conducted by the Paul Ehrlich Society for Chemotherapy. Two of the principal investigators from those trials, Wolfgang Hiddemann and Georg Maschmeyer, recognized the need for a standardized strategy for antimicrobial management in patients with acute myeloid leukemia undergoing intensive induction therapy. With the support of Xaver Schiel, a series of workshops was initiated in cooperation with the German AML Cooperative Group, and several guidelines were developed and applied clinically. In 1996 the DGHO formally accepted the antimicrobial working group as an official organ, electing Hiddemann and Maschmeyer as founding chairmen. From the beginning, the group deliberately looked beyond Germany’s borders, reaching out to Austria and Switzerland to strengthen what is known as the D-A-CH perspective and to make its recommendations applicable across different healthcare systems.
The scientific rationale for the working party’s existence rests on a simple clinical reality. Patients with hematological malignancies, particularly those with acute myeloid leukemia, experience profound and prolonged immunosuppression from both their disease and its treatment. In this population, the prevention, early diagnosis, and effective empirical or pre-emptive antimicrobial treatment of infections have become essential cornerstones of care, and improvements in survival among older patients with AML have been achieved in large part through better antifungal strategies, more effective antiemetic prophylaxis and platelet transfusions. Yet the therapeutic landscape has changed dramatically since 1996. Modern cancer treatment now encompasses immunotherapies designed to activate T cells, multi-tyrosine kinase inhibitors, monoclonal antibodies including bispecific T-cell engagers, and evolving concepts for allogeneic hematopoietic cell transplantation and graft-versus-host management. Each of these modalities produces a distinct profile of immunosuppression and a correspondingly distinct spectrum of infectious risks, creating a far broader diversity of vulnerability than was known historically and making the integration of infectious disease expertise into clinical hematology an essential demand.
Against this backdrop of rising complexity, the growing rates of antimicrobial resistance, including resistance to broad-spectrum antibacterial drugs such as carbapenems and to triazole antifungals, have heightened the urgency of antimicrobial stewardship and multidisciplinary cooperation. AGIHO’s response has been a continuous output of guidelines. The group has published 48 guidelines and research papers spanning all fields of infection in cancer patients, which have collectively received 1,273 citations, an average of 26 citations per paper. The guidelines are open access and regularly updated, with the group producing roughly one journal publication every six months, and condensed German- and English-language versions are maintained on the DGHO website. Since 2025, the platform medicalguideline.org has been used to support collaborative drafting with a standardized format, integrated literature management, and artificial intelligence-assisted tools.
The trajectory of AGIHO’s guidance illustrates how clinical standards have advanced. In the group’s first antifungal guideline in 2003, the only strong recommendation was for fluconazole prophylaxis in allogeneic bone marrow or stem cell transplant recipients. Subsequently, posaconazole took over as the preferred prophylactic agent on the strength of trial evidence showing that its broader spectrum, covering Aspergillus and emerging molds, prevented invasive fungal disease and death. That recommendation has remained unchanged in the most recent 2022 update simply because no new prophylactic drug has become available in nearly two decades, a drought that may end with the potential licensing of rezafungin for primary prophylaxis in allogeneic transplant recipients. Beyond prophylaxis, AGIHO helped shape key developments in the management of febrile neutropenia, which remains an oncological emergency: establishing the safety of empiric antibiotic monotherapy for most patients, emphasizing the importance of local epidemiology in first-line treatment, developing pre-emptive antifungal strategies, and creating risk scores and algorithms enabling safe outpatient management of standard-risk patients. With resistance mounting, stewardship principles have been woven into the guidelines, including the use of PEN-FAST criteria to identify penicillin-allergy patients eligible for penicillin derivatives and early discontinuation of empiric antibiotics after three to five days of defervescence irrespective of neutrophil count.
The COVID-19 pandemic tested the working party’s responsiveness and revealed the particular vulnerability of cancer patients to community-acquired respiratory viruses. AGIHO updated its COVID-19 guidance in close succession throughout the pandemic, covering diagnostics, viral shedding, vaccination, pharmacological prophylaxis and therapy in light of the omicron variants. The group’s members also contributed to defining and managing COVID-19-associated pulmonary aspergillosis through international consensus criteria. The updated 2025 guideline now extends these principles to influenza and respiratory syncytial virus, which cause significant morbidity and mortality in cancer patients and are managed under similar logic: high clinical awareness, rapid pathogen identification allowing early antiviral therapy to pre-empt progression to lower respiratory tract infection, and robust vaccination and infection-control strategies. A companion 2026 update on anti-infective vaccination strategies, published in The Lancet Oncology, addresses a new generation of cancer treatments, from antibody-drug conjugates to chimeric antigen receptor T cells and bispecific antibodies, each associated with previously unknown infection patterns; proteasome inhibitors in multiple myeloma, for instance, frequently precipitate herpes zoster. The review notes that vaccinations remain heavily underused in these populations, and that most studies measure antibody formation or T-cell-mediated immunity as surrogate markers rather than clinically meaningful endpoints such as infection rates or mortality.
AGIHO’s influence now extends well beyond the German-speaking countries. Since the early 2010s the group has been a core contributor to the European Conference on Infections in Leukaemia, alongside the European Organization for Research and Treatment of Cancer and the European Society for Blood and Marrow Transplantation, producing joint European guidelines on everything from empirical antimicrobial treatment to hepatitis and Pneumocystis infections. It works closely with the EBMT Infectious Diseases Working Party on cytomegalovirus, invasive aspergillosis and central nervous system infections, and since 2019 its principles for grading recommendations and evidence have been embedded in the global fungal guideline initiative led by the European Confederation of Medical Mycology, in cooperation with MSGERC, ISHAM and the American Society for Microbiology, guidelines now endorsed by more than one hundred national and regional societies worldwide. AGIHO members also helped establish the European Hematology Association’s Specialized Working Group on Infections in Hematology in 2017, which they continue to lead.
The group’s research infrastructure is anchored by two remarkable registries. SECRECY, initiated in 2013, is a real-world registry on central venous catheters that has accumulated more than 7,100 catheters across sixteen academic and non-academic centers, generating epidemiological data on catheter-related bloodstream infections, including analyses across the SARS-CoV-2 pandemic and by patient sex, and enabling registry-based randomized simulation studies that generate hypotheses for interventional trials. FungiScope, established in 2003, is an international registry of rare and emerging invasive fungal diseases with participants from 93 countries, holding more than 7,200 individual patient courses. Because the epidemiology of these pathogens precludes randomized controlled trials, the registry has become a unique source of peer-reviewed evidence on uncommon mold and yeast infections, informing international treatment guidelines and, notably, serving as an external matched control for regulatory purposes in the licensing of isavuconazole for mucormycosis, thereby supporting accelerated FDA and EMA approval pathways for innovative antifungals. During the pandemic, AGIHO members also supported EPICOVIDEHA, now EPIRESEHA, the largest registry of respiratory viral infections in patients with hematological diseases, and have launched new efforts on infections in acute myeloid leukemia and after bispecific antibody treatment.
Looking forward, the group is investing in its next generation. Young AGIHO, founded in 2023 at the joint annual conference of the German, Austrian and Swiss hematology-oncology societies, aims to interconnect early-career physicians and medical students across centers and disciplines, with members represented on all guideline panels and contributing to registry studies and trials, alongside regular virtual case presentations and journal clubs. Education has long been a pillar: since 2003 AGIHO has hosted an annual two-day training course that serves as a major networking platform for senior clinicians and young scientists alike, and the group presents bespoke symposia at all major national conferences. Its members regularly advise ministries of health on issues ranging from epidemiological developments to vaccine hesitancy and antimicrobial resistance. With several guideline updates currently in progress on invasive fungal disease, catheter-related infections, bacterial prophylaxis and infections in cellular therapy, and a new prospective study applying next-generation sequencing to cerebrospinal fluid from transplant patients with meningitis or encephalitis, the working party appears well positioned for its fourth decade. As the anniversary review concludes, close clinical monitoring remains the cornerstone of care for neutropenic patients, and it has remained the mandatory paradigm throughout the thirty years in service.
Subject of Research: Thirty-year history and scientific achievements of the Infectious Diseases Working Party (AGIHO) in preventing, diagnosing and treating infections in patients with hematological malignancies and cancer
Subject of Research: Cancer
Article Title: 30 years in service, 1996–2026: Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)
Article References: Cornely, O. A., Maschmeyer, G., Hiddemann, W., Bekaan, N., Giesen, N., Lass-Flörl, C., Mellinghoff, S. C., Petzer, V., Salmanton-García, J., Sandherr, M., Schalk, E., Schiel, X., Schmidt-Hieber, M., Seidel, D., Stemler, J., Teschner, D., Walti, L. N., & Rieger, C. T. (2026). 30 years in service, 1996–2026: Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Annals of Hematology, 105(8), Article 357. https://doi.org/10.1007/s00277-026-07194-8
Image Credits: AI Generated
DOI: 10.1007/s00277-026-07194-8
Keywords: AGIHO, DGHO, infections in hematology and oncology, febrile neutropenia, antifungal prophylaxis, clinical guidelines, antimicrobial stewardship, vaccination in cancer patients, FungiScope registry, hematopoietic cell transplantation, respiratory viral infections, Young AGIHO
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Nathaniel Bowman. (September 7, 2026). AGIHO Marks Three Decades of Infectious Disease Expertise, 1996–2026. Scienmag. https://scienmag.com/agiho-marks-three-decades-of-infectious-disease-expertise-1996-2026/
Nathaniel Bowman. “AGIHO Marks Three Decades of Infectious Disease Expertise, 1996–2026.” Scienmag, 7 September 2026, https://scienmag.com/agiho-marks-three-decades-of-infectious-disease-expertise-1996-2026/. Accessed 7 September 2026.
Nathaniel Bowman. “AGIHO Marks Three Decades of Infectious Disease Expertise, 1996–2026.” Scienmag. September 7, 2026. https://scienmag.com/agiho-marks-three-decades-of-infectious-disease-expertise-1996-2026/
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