Zhang Rongli, Chen Jing, Huang He, Ma Jun, Meng Fanyi, Tang Yongmin, Hu Jianda, Zhang Xi, Ji Yu, Ai Huisheng, Liang Yingmin, Wu Depei, Huang Xiaojun, Han Mingzhe
Hematopoietic Stem Cell Transplantation Center, Institute of Hematology and Hospital of Blood Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 288 Nanjing Road, Heping District, 300020, Tianjin, China.
Department of Hematology/Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 200129, Shanghai, China.
Int J Hematol. 2017 Aug;106(2):221-228. doi: 10.1007/s12185-017-2224-2. Epub 2017 Apr 7.
Invasive fungal disease (IFD) is a major cause of morbidity and mortality in acute leukemia (AL) patients. The impact of primary antifungal prophylaxis (PAP) on AL patients with different risk factors is unclear. We analyzed 2015 Chinese AL patients who received a total of 2274 chemotherapy courses, including 1410 courses in acute myeloid leukemia (AML) patients and 864 courses in acute lymphocytic leukemia (ALL) patients. The IFD incidence was significantly higher among AML than ALL patients (11.8 vs. 7.1%, P < 0.001) and in patients receiving induction chemotherapy than in those receiving consolidation chemotherapy (21.6 vs. 3.7%, P < 0.001). Induction chemotherapy, decreased serum albumin, indwelling central venous catheters, parenteral nutrition, and male gender were independent risk factors for IFD in AL patients, whereas PAP independently protected against IFD development. For patients on induction chemotherapy, PAP significantly reduced IFD incidence (P < 0.001). For patients on consolidation chemotherapy, however, PAP did not significantly alter IFD incidence, although PAP did lower IFD incidence in patients with certain risk factors. PAP is highly recommended for patients on induction therapy; for those on consolidation chemotherapy, PAP should be considered for patients who present with severe neutropenia, decreased albumin, and/or an indwelling central venous catheter.
侵袭性真菌病（IFD）是急性白血病（AL）患者发病和死亡的主要原因。初级抗真菌预防（PAP）对具有不同危险因素的AL患者的影响尚不清楚。我们分析了2015例接受总计2274个化疗疗程的中国AL患者，其中急性髓系白血病（AML）患者1410个疗程，急性淋巴细胞白血病（ALL）患者864个疗程。AML患者的IFD发病率显著高于ALL患者（11.8%对7.1%，P<0.001），接受诱导化疗的患者高于接受巩固化疗的患者（21.6%对3.7%，P<0.001）。诱导化疗、血清白蛋白降低、留置中心静脉导管、肠外营养和男性性别是AL患者发生IFD的独立危险因素，而PAP可独立预防IFD的发生。对于接受诱导化疗的患者，PAP显著降低了IFD发病率（P<0.001）。然而，对于接受巩固化疗的患者，PAP并未显著改变IFD发病率，尽管PAP确实降低了某些危险因素患者的IFD发病率。强烈建议接受诱导治疗的患者使用PAP；对于接受巩固化疗的患者，对于出现严重中性粒细胞减少、白蛋白降低和/或留置中心静脉导管的患者应考虑使用PAP。
