Della Pepa Roberta, Picardi M, Sorà F, Stamouli M, Busca A, Candoni A, Delia M, Fanci R, Perriello V, Zancanella M, Nosari A, Salutari P, Marchesi F, Pane F, Pagano L
Department of Clinical Medicine and Surgery, Hematology, Federico II University, via Sergio Pansini, 5, Naples, 80131, Italy.
Hematology Catholic University Sacro Cuore, Rome, Italy.
Support Care Cancer. 2016 Sep;24(9):3839-45. doi: 10.1007/s00520-016-3208-0. Epub 2016 Apr 14.
Chronic disseminated candidiasis (CDC) is a complication of Candida infection in immunocompromised patients, involving the liver and spleen, and rarely other organs. The aim of the study is to identify the best antifungal drug for hematologic immunocompromised patients with CDC.
In this multicentric retrospective study, the charts of 20 patients with CDC following cytotoxic agent protocols for hematological malignancies, diagnosed from 2003 to 2013, were analyzed. The response to systemic antifungal therapy within 90 days from CDC diagnosis and the possible delay in chemotherapy plan, due to the infection, were evaluated.
Six patients were treated with high-dose (HD; 5 mg/kg/daily) liposomal amphotericin B (L-AmB), whereas three received standard-dose (SD) L-AmB (3 mg/kg/daily). Azoles were given to six patients; the remaining five were treated with echinocandins. All patients treated with HD L-AmB (6/6-100 %) achieved complete resolution of CDC; one of them had to interrupt the chemotherapy program for the infection. In the SD L-AmB group, treatment failed in the 100 % of cases and one patient had to delay chemotherapy for the infection. Of the six patients who received azoles, two achieved complete resolution of the infection, four experienced treatment failure, and only three performed chemotherapy as planned. Echinocandins treatment resulted in complete resolution of the infection in 2/5 cases, partial response in 2/5 cases, and failure in one case. In this group, 3/5 patients completed chemotherapy as planned.
This study shows that HD L-AmB was particularly effective against CDC in hematologic patients, allowing most patients to continue cytotoxic agent program.
慢性播散性念珠菌病（CDC）是免疫功能低下患者念珠菌感染的一种并发症，累及肝脏和脾脏，很少累及其他器官。本研究的目的是确定治疗血液系统免疫功能低下的CDC患者的最佳抗真菌药物。
在这项多中心回顾性研究中，分析了2003年至2013年期间诊断为血液系统恶性肿瘤且按照细胞毒药物方案治疗后发生CDC的20例患者的病历。评估了自CDC诊断起90天内全身抗真菌治疗的反应以及由于感染导致化疗计划可能延迟的情况。
6例患者接受高剂量（HD；5mg/kg/每日）脂质体两性霉素B（L-AmB）治疗，3例接受标准剂量（SD）L-AmB（3mg/kg/每日）治疗。6例患者给予唑类药物治疗；其余5例接受棘白菌素治疗。所有接受HD L-AmB治疗的患者（6/6 - 100%）CDC均完全缓解；其中1例因感染不得不中断化疗方案。在SD L-AmB组中，100%的病例治疗失败，1例患者因感染不得不延迟化疗。在接受唑类药物治疗的6例患者中，2例感染完全缓解，4例治疗失败，只有3例按计划进行了化疗。棘白菌素治疗使2/5的病例感染完全缓解，2/5的病例部分缓解，1例失败。在该组中，3/5的患者按计划完成了化疗。
本研究表明，HD L-AmB对血液系统患者的CDC特别有效，使大多数患者能够继续细胞毒药物治疗方案。
