Isavuconazole Prophylaxis in Patients With Hematologic Malignancies and Hematopoietic Cell Transplant Recipients
Isavuconazole Prophylaxis in Patients With Hematologic Malignancies and Hematopoietic Cell Transplant Recipients
复制标题
DOI：
10.1093/cid/ciz282
复制
发表时间：
2020-03-01
影响因子：
11.8
通讯作者：
Hakki, Morgan
中科院分区：
文献类型：
--
作者：
Fontana, Lauren;Perlin, David S.;Hakki, Morgan
背景。Isavuconazole （ISA）是血液恶性肿瘤高危患者或造血细胞移植（HCT）接受者的初级霉菌活性预防的有吸引力的候选药物。然而，支持在这些患者中使用ISA进行初级预防的数据缺乏。我们对2016年9月1日至2018年9月30日期间接受>= 7天ISA一级预防的成人血液病恶性患者和HCT接受者的突破性侵袭性真菌感染（bIFIs）进行了回顾性研究。比较了ISA患者与泊沙康唑（POS）和伏立康唑（VOR）患者在同一时间段的bIFIs发生率。145名患者接受了197个ISA预防疗程。在ISA预防的中位持续时间为14天后，发生了12例bifi（烟曲霉[5]、曲霉[2]、Mucorales[2]、镰刀菌[2]和光假丝酵母[1]），占8.3%的患者和6.1%的疗程。所有的bis都发生在中性粒细胞减少期间。7例患者（58.3%）在bIFI发病42天内死亡。此外，在研究期间，在新发或复发/难治性急性髓性白血病患者中，bIFIs并发10.2%的ISA、4.1%的POS和1.1%的VOR病程，侵袭性肺曲霉病（IPA）并发6.8%的ISA、1.3%的POS和零VOR病程。虽然ISA已被批准用于治疗侵袭性曲霉病和毛霉病，但我们观察到使用ISA进行一级预防的bIFI，特别是IPA的发生率增加。这些结果支持需要进一步研究以确定ISA作为初级预防的作用。
Background. Isavuconazole (ISA) is an attractive candidate for primary mold-active prophylaxis in high-risk patients with hematologic malignancies or hematopoietic cell transplant (HCT) recipients. However, data supporting the use of ISA for primary prophylaxis in these patients are lacking.Methods. We conducted a retrospective review of breakthrough invasive fungal infections (bIFIs) among adult hematologic malignancy patients and HCT recipients who received >= 7 days of ISA primary prophylaxis between 1 September 2016 and 30 September 2018. The incidence of bIFIs in patients receiving ISA was compared to those receiving posaconazole (POS) and voriconazole (VOR) during the same time period.Results. One hundred forty-five patients received 197 courses of ISA prophylaxis. Twelve bIFIs (Aspergillus fumigatus [5], Aspergillus species [2], Mucorales [2], Fusarium species [2], and Candida glabrata [1]) occurred, representing 8.3% of patients and 6.1% of courses, after a median duration of 14 days of ISA prophylaxis. All bIFIs occurred during periods of neutropenia. Seven patients (58.3%) died within 42 days of onset of bIFI. In addition, bIFIs complicated 10.2% of ISA, 4.1% of POS, and 1.1% of VOR courses among patients with de novo or relapsed/refractory acute myeloid leukemia during the study period, with invasive pulmonary aspergillosis (IPA) complicating 6.8% of ISA, 1.3% of POS, and zero VOR courses.Conclusions. Although ISA has been approved for treatment of invasive Aspergillus and mucormycosis, we observed an increased rate of bIFI, notably IPA, using ISA for primary prophylaxis. These results support the need for further study to determine the role of ISA as primary prophylaxis.