Invasive fungal infection in patients receiving chemotherapy for hematological malignancy: a multicenter, prospective, observational study in China
Invasive fungal infection in patients receiving chemotherapy for hematological malignancy: a multicenter, prospective, observational study in China
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DOI：
10.1007/s13277-014-2649-7
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发表时间：
2015-02-01
期刊：
影响因子：
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通讯作者：
Huang, Xiaojun
中科院分区：
文献类型：
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作者：
Sun, Yuqian;Huang, He;Huang, Xiaojun
本文对中国地区血液系统恶性肿瘤化疗患者发生侵袭性真菌感染的流行病学、危险因素、处理及转归进行了研究。对IFI危险因素进行单因素分析和多因素Logistic回归分析。总共有4192名患者接受了4889个化疗疗程[平均年龄40.7岁，其中58.4%为男性，16.9%为儿童(18岁)]。最常见的血液病是急性髓系白血病(AML，28.5%)、非霍奇金淋巴瘤(NHL，26.3%)和急性淋巴细胞白血病(ALL，20.2%)。严重的中性粒细胞减少(中性粒细胞绝对计数[ANC]和500/mm(3))发生在1/3疗程(1,633/4,889，33.4%)之后。确诊/可能IFI的发生率为2.1%/化疗疗程，在骨髓增生异常综合征(MDS，4.94%)、急性高白细胞白血病(AHL，4.76%)、急性髓系白血病(AML)(3.83%)或诱导化疗患者中较高。危险因素包括ANC<；500/mm(3)[优势比(OR)3.60]、AML或MDS(OR 1.97)、诱导化疗(OR 2.58)、既往IFI(OR 3.08)、男性(OR 1.74)。抗真菌药物占化疗疗程的1/4(1211/4889，24.8%)，包括一次/二次预防(n=827，16.9%)和/或治疗(n=655，13.4%；86.9%)，其中经验性(84.3%)、预防性(8.6%)或靶向性(7.1%)。每个化疗疗程后的总死亡率(1.5%)在已证实/可能的(11.7%)和可能的IFI(8.2%)中增加。综上所述，IFI在MDS、AHL、AML或诱导化疗中更为常见，并且显著增加了死亡率。接受AML或MDS诱导化疗的中性粒细胞减少患者和既往IFI患者的风险尤其高。抗真菌预防显示出独立的保护作用，但即使在高危患者中也不常用。相比之下，经验性抗真菌药物得到了广泛应用。
This stud y examined the epidemiology, risk factors, management, and outcome of invasive fungal infection (IFI) in patients receiving chemotherapy for hematological malignancy in China. IFI risk factors were analyzed using univariate analysis and multivariate logistic regression. In total, 4,192 patients receiving 4,889 chemotherapy courses were enrolled [mean age 40.7 years, 58.4 % male, 16.9 % children (< 18 years)]. The most common hematological diseases were acute myeloid leukemia (AML, 28.5 %), non-Hodgkin lymphoma (NHL, 26.3 %), and acute lymphoblastic leukemia (ALL, 20.2 %). Severe neutropenia (absolute neutrophil count [ANC] < 500/mm(3)) occurred after one third (1,633/4,889, 33.4 %) of chemotherapy courses. Incidence of proven/probable IFI was 2.1 % per chemotherapy course and higher in patients with myelodysplastic syndrome (MDS, 4.94 %), acute hyperleukocytic leukemia (AHL, 4.76 %), AML (3.83 %), or induction chemotherapy. Risk factors included ANC < 500/mm(3) [odds ratio (OR) 3.60], AML or MDS (OR 1.97), induction chemotherapy (OR 2.58), previous IFI (OR 3.08), and being male (OR 1.74). Antifungal agents, prescribed in one quarter (1,211/4,889, 24.8 %) of chemotherapy courses, included primary/secondary prophylaxis (n = 827, 16.9 %) and/or treatment (n = 655, 13.4 %; 86.9 % triazoles), which was empirical (84.3 %), pre-emptive (8.6 %), or targeted (7.1 %). Overall mortality following each chemotherapy course (1.5 %) increased in proven/probable (11.7 %) and possible IFI (8.2 %). In summary, IFI was more common in MDS, AHL, AML, or induction chemotherapy, and substantially increased mortality. Neutropenic patients receiving induction chemotherapy for AML or MDS and those with previous IFI were at particular risk. Antifungal prophylaxis showed an independent protective effect but was not commonly used, even in high-risk patients. By contrast, empiric antifungals were widely used.