Invasive aspergillosis following hematopoietic cell transplantation: Outcomes and prognostic factors associated with mortality
Invasive aspergillosis following hematopoietic cell transplantation: Outcomes and prognostic factors associated with mortality
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DOI：
10.1086/510592
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发表时间：
2007-02-15
影响因子：
11.8
通讯作者：
Marr, Kieren A.
中科院分区：
文献类型：
--
作者：
Upton, Arlo;Kirby, Katharine A.;Marr, Kieren A.
背景。侵袭性曲霉菌病 (IA) 是造血细胞移植 (HCT) 后感染相关死亡的主要原因。本研究的目的是确定与长期结果相关的生存概率和预后因素。方法。包括 1990 年 1 月 1 日至 2004 年 12 月 31 日期间在 Fred Hutchinson 癌症研究中心的 HCT 接受者中确诊和可能诊断为 IA 的病例。患者数据是从前瞻性维护的数据库中通过回顾性临床图表审查收集的。使用Kaplan-Meier曲线估计生存率，并使用Cox回归模型进行多变量分析。结果。已发现四百五例病例。 2002 年至 2004 年间被诊断为 IA 的患者在诊断后 90 天的生存概率高于前几年诊断为 IA 的患者（45% vs. 22%；）。与全因死亡率独立相关的危险因素包括 HCT 前肺功能损伤 P < .001、接受人类白细胞抗原不匹配的干细胞、中性粒细胞减少症、胆红素和肌酐水平升高、每天接受 >= 2 mg/kg 的皮质类固醇、播散性和证实的 IA 以及 HCT 后 140 天发生的 IA。与全因死亡风险降低相关的因素包括接受非清髓性预处理和外周血干细胞。在仅限于接受抗真菌治疗的患者的归因死亡率亚分析中，接受伏立康唑与预防 IA 相关死亡独立相关。结论。近年来，HCT 后诊断为 IA 的患者死亡率显着下降，这与移植实践的多种变化相一致，包括使用非清髓性预处理方案、接受外周血干细胞、更及时地诊断 IA 以及使用伏立康唑。
Background. Invasive aspergillosis (IA) is a leading cause of infection-related mortality following hematopoietic cell transplantation (HCT). The aim of this study was to determine the probability of survival and prognostic factors associated with outcomes over a long period of time.Methods. Cases of proven and probable IA diagnosed in HCT recipients at the Fred Hutchinson Cancer Research Center from 1 January 1990 through 31 December 2004 were included. Patient data were collected from a prospectively maintained database and by retrospective clinical chart review. Survival was estimated using Kaplan-Meier curves, and Cox regression models were used for multivariable analyses.Results. Four hundred five cases were identified. The probability of survival at 90 days after diagnosis was higher for patients identified as having IA between 2002 and 2004 than for patients whose IA was diagnosed in preceding years (45% vs. 22%;). Risk factors independently associated with all-cause mortality include P < .001 impairment in pulmonary function before HCT, receipt of human leukocyte antigen-mismatched stem cells, neutropenia, elevated bilirubin and creatinine levels, receipt of corticosteroids at >= 2 mg/kg per day, disseminated and proven IA, and IA occurring 140 days after HCT. Factors associated with a decreased risk of all-cause mortality included receipt of nonmyeloablative conditioning and peripheral blood stem cells. In a subanalysis of attributable mortality restricted to patients receiving antifungal therapy, receipt of voriconazole was independently associated with protection from IA-related death.Conclusions. There has been a significant decrease in mortality in patients with a diagnosis of IA following HCT in recent years, coinciding with multiple changes in transplantation practices, including use of nonmyeloablative conditioning regimens, receipt of peripheral blood stem cells, more prompt diagnosis of IA, and use of voriconazole.