Department I of Internal Medicine, Infectious Diseases, University of Cologne, Cologne, Germany.
Mycoses. 2011 Sep;54(5):e449-55. doi: 10.1111/j.1439-0507.2010.01947.x. Epub 2010 Oct 11.
In 2008, the European Organisation for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) published revised definitions for diagnosing invasive fungal disease. A previous prospective trial of liposomal amphotericin B for invasive mould disease (AmBiLoad) used modified EORTC/MSG 2002 criteria. We wished to re-evaluate the response and survival based on the revised definitions to compare the outcomes of early vs. late treatment. Patients who had received an allogeneic haematopoietic stem cell transplant or who were neutropaenic (absolute neutrophil count <500 μl(-1) within 14 days of study entry) had been recruited on the basis of a halo or air crescent sign on chest computerised tomography. Originally classified as probable invasive mould disease, they were categorised as possible invasive mould disease using 2008 criteria. Patients had received liposomal amphotericin B at either 3 or 10 mg kg(-1) QD for 14 days, followed by 3 mg kg(-1) QD. Response at end of treatment and the 12-week survival were re-calculated according to 2008 definitions. Six-week survival was estimated by Kaplan-Meier analysis. Of 201 patients with invasive mould disease, 118 (59%) had a diagnosis based on halo signs (possible cases). Mycological evidence was present in 83 (41%) cases (probable/proven cases). Survival rates at 12 weeks for possible vs. probable/proven cases in the 3 mg kg(-1) QD group were 82% vs. 58% (P = 0.006), and 65% vs. 50% (P = 0.15) in the 10 mg kg(-1) QD group. At 6 weeks, rates were 87% vs. 69% in the 3 mg kg(-1) QD group (P = 0.009), and 75% vs. 61% in the 10 mg kg(-1) QD group (P = 0.01). Patients with possible invasive mould disease based on EORTC/MSG 2008 criteria had improved survival rates compared with those treated for probable/proven invasive mould disease. As possible invasive mould disease probably reflects an early-stage of disease, a better outcome might be expected when treatment with liposomal amphotericin B is started preemptively.
2008 年，欧洲癌症研究与治疗组织/霉菌病研究组（EORTC/MSG）发布了修订的侵袭性真菌感染诊断定义。先前针对侵袭性霉菌病的脂质体两性霉素 B 前瞻性试验（AmBiLoad）使用了改良的 EORTC/MSG 2002 标准。我们希望根据修订后的定义重新评估反应和生存情况，以比较早期和晚期治疗的结果。基于胸部计算机断层扫描的 halo 或 air crescent 征，入组了接受异基因造血干细胞移植或中性粒细胞减少症（研究入组后 14 天内绝对中性粒细胞计数 <500 μl(-1)）的患者。最初被归类为可能的侵袭性霉菌病，根据 2008 年的标准将其归类为可能的侵袭性霉菌病。患者接受了 14 天的 3 或 10 mg/kg QD 脂质体两性霉素 B 治疗，随后是 3 mg/kg QD。根据 2008 年的定义重新计算了治疗结束时的反应和 12 周的生存率。通过 Kaplan-Meier 分析估计 6 周生存率。在 201 例侵袭性霉菌病患者中，118 例（59%）基于 halo 征诊断（可能病例）。83 例（41%）存在真菌学证据（确诊/证实病例）。在 3 mg/kg QD 组中，可能病例与确诊/证实病例的 12 周生存率分别为 82% vs. 58%（P = 0.006）和 65% vs. 50%（P = 0.15）。在 10 mg/kg QD 组中，分别为 87% vs. 69%（P = 0.009）和 75% vs. 61%（P = 0.01）。基于 EORTC/MSG 2008 标准，可能患有侵袭性霉菌病的患者与接受确诊/证实侵袭性霉菌病治疗的患者相比，生存率提高。由于可能的侵袭性霉菌病可能反映疾病的早期阶段，因此当预防性开始使用脂质体两性霉素 B 治疗时，可能会获得更好的结果。
