Aspergillus infections are a threat to in patients with hematological malignancies. Known risk factors are profound and long
lasting neutropenia, uncontrolled graft versus host disease, continuous administration of steroids and environmental factors such as hospital
construction. Numerous efforts have been undertaken for prophylaxis of invasive aspergillosis in high-risk populations. Most of them
failed to demonstrate survival advantages. Prophylaxis makes sense, since diagnosis and treatment of invasive aspergillosis remain difficult.
The introduction of non-culture based tools for the diagnosis of invasive aspergillosis is an important step forward for early and sensitive
diagnosis of invasive aspergillosis. Early treatment is the cornerstone of a successful management of invasive aspergillosis. Substantial
improvement came with the introduction of lipid formulations of amphotericin B in the early 1990s. Voriconazole was the first
azole that improved the overall survival for patients with invasive aspergillosis. Newer azoles and the echinocandins were introduced for
the treatment of invasive aspergillosis in the late 1990s. Voriconazole and liposomal amphotericin B allow a safer and more effective
treatment of invasive aspergillosis when compared with amphotericin B-desoxycholate. Combination of antifungal agents has been introduced
in clinical trials. Up to now no significant benefit has been obtained with antifungal combination compared to voriconazole alone.
Because mortality of invasive aspergillosis remains up to more than 50%, prophylaxis, early diagnosis and early initiation of antifungal
therapy are of utmost importance for the reduction of invasive aspergillosis related mortality. Despite all advances in the management of
invasive aspergillosis important questions remain unresolved. This article reviews the current state and new insights in the management
of invasive aspergillosis and points out clinicians unmet needs.