Vehreschild Jörg J, Sieniawski Michal, Reuter Stefan, Arenz Dorothee, Reichert Dietmar, Maertens Johan, Böhme Angelika, Silling Gerda, Martino Rodrigo, Maschmeyer Georg, Rüping Maria J G T, Ullmann Andrew J, Cornely Oliver A
Klinik I für Innere Medizin, Klinikum der Universität zu Köln, Cologne, Germany.
Int J Antimicrob Agents. 2009 Nov;34(5):446-50. doi: 10.1016/j.ijantimicag.2009.06.025. Epub 2009 Aug 22.
Patients surviving invasive fungal disease (IFD) and needing further antineoplastic chemotherapy are at high risk of recurrent fungal infection. In the absence of randomised controlled trials in this area, secondary prophylactic regimens are diverse. From 448 patients registered with the Multinational Case Registry of Secondary Antifungal Prophylaxis, we performed an analysis of patients receiving caspofungin (CAS) or itraconazole (ITC). All patients had an underlying haematological malignancy and had been diagnosed with an episode of IFD earlier in their course of treatment. Data collected comprised demographics, underlying disease, first episode of IFD, antifungal prophylaxis, incidence and outcome of breakthrough IFD and survival. A total of 75 patients were evaluated, comprising 28 receiving CAS and 47 receiving ITC. Patients in the CAS group were more likely to have had progression of underlying disease (32.1% vs. 8.5%; P=0.028) as well as incomplete response of initial IFD at baseline (85.7% vs. 57.4%; P=0.005). Allogeneic stem cell transplantation was more prevalent in patients receiving CAS (46.4% vs. 14.9%; P=0.010). There was no difference in the occurrence of breakthrough IFD between both groups (32.1% vs. 31.9%). Treatment outcomes for recurrent IFD and overall mortality did not differ between groups. Both ITC and CAS were equally effective in preventing second episodes of IFD. Patients with uncontrolled first IFD, uncontrolled underlying disease or those receiving stem cell transplantation were more likely to have received CAS prophylaxis. Despite antifungal prophylaxis, risk of breakthrough IFD was high in both groups.
侵袭性真菌病（IFD）幸存者且需要进一步进行抗肿瘤化疗的患者，发生真菌反复感染的风险很高。由于该领域缺乏随机对照试验，二级预防方案多种多样。我们从多国二级抗真菌预防病例登记处登记的448例患者中，对接受卡泊芬净（CAS）或伊曲康唑（ITC）治疗的患者进行了分析。所有患者均患有潜在血液系统恶性肿瘤，且在治疗过程中较早时被诊断为IFD发作。收集的数据包括人口统计学、基础疾病、首次IFD发作、抗真菌预防、突破性IFD的发生率和结局以及生存率。总共评估了75例患者，其中28例接受CAS治疗者，47例接受ITC治疗者。CAS组患者基础疾病进展的可能性更大（32.1%对8.5%；P=0.028），且基线时初始IFD的反应不完全者更多（85.7%对57.4%；P=0.005）。接受CAS治疗的患者中异基因干细胞移植更为普遍（46.4%对14.9%；P=0.010）。两组之间突破性IFD的发生率无差异（32.1%对31.9%）。两组之间复发性IFD的治疗结局和总死亡率无差异。ITC和CAS在预防IFD的第二次发作方面同样有效。首次IFD未得到控制、基础疾病未得到控制或接受干细胞移植的患者更有可能接受CAS预防。尽管进行了抗真菌预防，但两组中突破性IFD的风险都很高。
