Imataki O, Kami M, Kim S-W, Gotoh M, Komaba S, Kasai M, Hashino S, Naito K, Masuda M, Anan K, Teshima H, Togitani K, Inoue T, Nishimura M, Adachi Y, Fukuhara T, Yamashita T, Uike N, Kobayashi Y, Hamaguchi M, Higuchi M, Kawakami K, Takaue Y
Hematopoietic Stem Cell Transplant Unit, National Cancer Center Hospital, Tokyo, Japan.
Bone Marrow Transplant. 2004 Jun;33(12):1173-9. doi: 10.1038/sj.bmt.1704526.
We conducted a nationwide survey to define incidence of deep fungal infections and fungal prophylaxis practices after HSCT. In all, 63 institutions responded. Total number of in-patient transplantations was 935: 367 autologous, 414 allogeneic myeloablative, and 154 allogeneic reduced-intensity (RIST) (n=154). Number of patients who were cared for in a clean room at transplant was 261 (71%) in autologous, 409 (99%) in conventional and 93 (66%) in RIST, respectively. All patients received prophylactic antifungal agents; 89% fluconazole. Number of patients who received the dosage recommended in the CDC guidelines (400 mg/day) was 135 (42%) in conventional transplant and 34 (30%) in RIST (P=0.037). Number of patients who received fluconazole until engraftment and beyond day 75 in conventional transplant vs RIST was, respectively, 324 (100%) vs 109 (97%), and 39 (12%) vs 18 (16%), with no significant difference between the two groups. A total of 37 patients (4.0%) were diagnosed with deep fungal infections; autologous transplantation (0.03%), conventional transplantation (6.0%) and RIST (7.1%). Wide variations in antifungal prophylaxis practice according to the type of transplant and the institutions, and deep fungal infection remain significant problems in RIST.
我们开展了一项全国性调查，以确定造血干细胞移植（HSCT）后深部真菌感染的发生率及真菌预防措施。共有63家机构做出回应。住院移植总数为935例：自体移植367例，异基因清髓性移植414例，异基因减低强度预处理移植（RIST）154例（n = 154）。移植时在洁净室接受护理的患者数量分别为：自体移植261例（71%），传统移植409例（99%），RIST移植93例（66%）。所有患者均接受预防性抗真菌药物治疗；89%使用氟康唑。在传统移植中，按照美国疾病控制与预防中心（CDC）指南推荐剂量（400毫克/天）接受治疗的患者有135例（42%），在RIST移植中有34例（30%）（P = 0.037）。在传统移植与RIST移植中，接受氟康唑直至植入且超过第75天的患者数量分别为324例（100%）对109例（97%），以及39例（12%）对18例（16%），两组之间无显著差异。共有37例患者（4.0%）被诊断为深部真菌感染；自体移植（0.03%）、传统移植（6.0%）和RIST移植（7.1%）。根据移植类型和机构不同，抗真菌预防措施存在很大差异，并且深部真菌感染在RIST移植中仍然是严重问题。
