Empirical Versus Preemptive Antifungal Therapy

DISEASE CHARACTERISTICS: * Diagnosis of acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) * Newly diagnosed disease or disease in first relapse after hematological remission lasting for a minimum of 6 months AND meets one of the following criteria: * Starting remission-induction chemotherapy within 3 days prior to study randomization * Starting myeloablative conditioning regimen to prepare for a first allogeneic hematopoietic stem cell transplantation within 3 days prior to study randomization * Planning a hospital admission for the duration of the neutropenic phase (ANC \< 0.5 x 10\^9 /L) * Planning to receive oral or intravenous fluconazole for Candida prophylaxis at a dose of 400 mg/day * Fluconazole is discontinued during caspofungin acetate administration * No previous or current history of proven or probable invasive fungal disease (IFD) PATIENT CHARACTERISTICS: * See Disease Characteristics * Not pregnant or nursing * Negative pregnancy test * Fertile patients muse use effective contraception during and for at least 3 months after completion of study therapy * No current clinical diagnosis of pneumonia * No serious, uncontrolled, concomitant disease or comorbidity that, in the opinion of the investigator, may compromise adherence to the study protocol * No history of allergy or any adverse reaction to echinocandin drugs (i.e., caspofungin acetate, micafungin, or anidulafungin) * No hypersensitivity to caspofungin active substance or to an…