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For patients with acute myeloid leukaemia (AML) or myelodysplastic syndrome (MDS), posaconazole for fungal prophylaxis is standard practice. However, therapeutic drug monitoring (TDM) is frequently omitted, despite clear recommendations from the National Comprehensive Cancer Network (NCCN) and Infectious Diseases Society of America (IDSA).1 2 The absorption of the delayed-release formulation remains unpredictable and is influenced by gastrointestinal function, mucosal integrity, and drug interactions, all of which are common in this patient population.3