Crassard N, Hadden H, Pondarré C, Hadden R, Galambrun C, Piens M A, Pracros J P, Souillet G, Basset T, Berthier J C, Philippe N, Bertrand Y
Department of Pediatric Hematology, Hôpital Debrousse, Lyon, France.
Transpl Infect Dis. 2008 Jun;10(3):177-83. doi: 10.1111/j.1399-3062.2008.00304.x. Epub 2008 Mar 4.
Despite progress in diagnosis and treatment, invasive aspergillosis (IA) remains a principal cause of mortality due to infection after allogeneic hematopoietic stem cell transplantation (AHSCT). In order to clarify the course of IA among children receiving an AHSCT before the advent of new drugs such as voriconazole or caspofungin, we retrospectively reviewed the medical records of all proven and probable IA between January 1986 and December 2000. 1) Ten children developed IA after AHSCT, mostly long after transplantation. Overall incidence was 2.7%. Seven of those children experienced 1 or more complications after AHSCT and before IA. Mortality was 90% with a median survival of 23 days (2-90). 2) Five children underwent AHSCT after a previous episode of IA. All patients were treated with systemic antifungal therapy combined with surgery. Median time between IA and AHSCT was 110 days (73-370). Two children were diagnosed with IA relapse after transplantation. One child was cured while the other died of IA and AHSCT complications. AHSCT could be considered even in the setting of previous IA, but established strategies implementing newer less toxic antifungal agents as treatment or prophylaxis in high-risk patients are needed.
尽管在诊断和治疗方面取得了进展，但侵袭性曲霉病（IA）仍然是异基因造血干细胞移植（AHSCT）后感染导致死亡的主要原因。为了阐明在伏立康唑或卡泊芬净等新药出现之前接受AHSCT的儿童中IA的病程，我们回顾性分析了1986年1月至2000年12月期间所有确诊和疑似IA的病历。1）10名儿童在AHSCT后发生IA，大多在移植后很长时间。总体发病率为2.7%。其中7名儿童在AHSCT后且在发生IA之前经历了1种或更多并发症。死亡率为90%，中位生存期为23天（2 - 90天）。2）5名儿童在先前发生IA后接受了AHSCT。所有患者均接受了全身抗真菌治疗并联合手术。IA与AHSCT之间的中位时间为110天（73 - 370天）。2名儿童在移植后被诊断为IA复发。1名儿童治愈，另1名儿童死于IA和AHSCT并发症。即使在先前有IA的情况下也可以考虑进行AHSCT，但需要制定在高危患者中实施毒性较小的新型抗真菌药物进行治疗或预防的既定策略。
