Miyakoshi Shigesaburo, Kusumi Eiji, Matsumura Tomoko, Hori Akiko, Murashige Naoko, Hamaki Tamae, Yuji Koichiro, Uchida Naoyuki, Masuoka Kazuhiro, Wake Atsushi, Kanda Yoshinobu, Kami Masahiro, Tanaka Yuji, Taniguchi Shuichi
Department of Hematology, Toranomon Hospital, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan.
Biol Blood Marrow Transplant. 2007 Jul;13(7):771-7. doi: 10.1016/j.bbmt.2007.02.012.
Invasive fungal infection (IFI) is a significant complication after allogeneic hematopoietic stem cell transplantation (HSCT); however, we have little information on its clinical features after reduced intensity cord blood transplantation (RICBT) for adults. We reviewed medical records of 128 patients who underwent RICBT at Toranomon Hospital between March 2002 and November 2005. Most of the patients received purine-analogbased preparative regimens. Graft-versus-host disease (GVHD) prophylaxis was a continuous infusion of either tacrolimus 0.03 mg/kg or cyclosporine 3 mg/kg. IFI was diagnosed according to the established EORTC/NIH-MSG criteria. IFI was diagnosed in 14 patients. Thirteen of the 14 had probable invasive pulmonary aspergillosis and the other had fungemia resulting from Trichosporon spp. Median onset of IFI was day 20 (range: 1-82), and no patients developed IFI after day 100. Three-year cumulative incidence of IA was 10.2%. Four of the 13 patients with invasive aspergillosis (IA) developed grade II-IV acute GVHD, and their IA was diagnosed before the onset of acute GVHD. The mortality rate of IFI was 86%. Multivariate analysis revealed that the use of prednisolone >0.2 mg/kg (relative risk 7.97, 95% confidence interval 2.24-28.4, P = .0014) was a significant risk factor for IA. This study suggests that IFI is an important cause of deaths after RICBT, and effective strategies are warranted to prevent IFI.
侵袭性真菌感染（IFI）是异基因造血干细胞移植（HSCT）后的一种严重并发症；然而，对于成人减低强度脐带血移植（RICBT）后IFI的临床特征，我们了解甚少。我们回顾了2002年3月至2005年11月在虎之门医院接受RICBT的128例患者的病历。大多数患者接受了基于嘌呤类似物的预处理方案。移植物抗宿主病（GVHD）预防采用持续输注他克莫司0.03mg/kg或环孢素3mg/kg。IFI根据既定的欧洲癌症研究与治疗组织/美国国立卫生研究院真菌病研究组（EORTC/NIH-MSG）标准进行诊断。14例患者被诊断为IFI。14例中的13例患有可能的侵袭性肺曲霉病，另1例患有毛孢子菌属引起的真菌血症。IFI的中位发病时间为第20天（范围：1-82天），且无患者在第100天后发生IFI。侵袭性曲霉病（IA）的3年累积发病率为10.2%。13例侵袭性曲霉病患者中有4例发生了II-IV级急性GVHD，且他们的IA在急性GVHD发作前被诊断。IFI的死亡率为86%。多变量分析显示，使用泼尼松龙>0.2mg/kg（相对风险7.97，95%置信区间2.24-28.4，P = 0.0014）是IA的一个显著危险因素。本研究表明，IFI是RICBT后死亡的一个重要原因，需要有效的策略来预防IFI。
