Division of Haematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Division of Infectious Disease, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
J Microbiol Immunol Infect. 2020 Feb;53(1):106-114. doi: 10.1016/j.jmii.2018.01.002. Epub 2018 Jan 31.
BACKGROUND/PURPOSE: This study was aimed to investigate clinical characteristics and treatment outcomes of pulmonary invasive fungal infection (IFI) among patients with hematological malignancy.
All patients with hematological malignancy who were treated at a medical centre from 2008 to 2013 were evaluated. Pulmonary IFI was classified according to the European Organization for Research and Treatment of Cancer 2008 consensus.
During the study period, 236 (11.3%) of 2083 patients with hematological malignancy were diagnosed as pulmonary IFI, including 41 (17.4%) proven, 75 (31.8%) probable, and 120 (50.8%) possible cases. Among the 116 patients of proven and probable cases of pulmonary IFI, aspergillosis alone (n = 90, 77.6%) was predominant, followed by cryptococcosis alone (n = 9, 7.8%), and mucormycosis (n = 4, 3.4%). The overall incidence of patients with pulmonary IFI was 5.9 per 100 patient-years. The highest incidence (per 100 patient-year) was found in patients with acute myeloid leukaemia (13.7) followed by acute lymphoblastic leukaemia (11.3), and myelodysplastic syndrome/severe aplastic anaemia (6.7). Fourteen (5.9%) of the 236 patients with pulmonary IFI died within 12 weeks after diagnosis of pulmonary IFI. Univariate analysis revealed that elderly age (>65 years) (P = 0.034), lack of response to anti-fungal treatment (P < 0.001), and admission to the intensive care unit (ICU) (P < 0.001) were predictors of poor prognosis. However, only admission to the ICU was an independent predictor of poor prognosis for 12-week mortality (P = 0.022) based on multivariate analysis.
Patients with acute leukaemia and myelodysplastic syndrome/severe aplastic anaemia were at high risk of pulmonary IFI.
背景/目的：本研究旨在探讨血液病患者肺部侵袭性真菌感染（IFI）的临床特征和治疗结局。
评估了 2008 年至 2013 年在一家医疗中心接受治疗的所有血液病患者。根据欧洲癌症研究与治疗组织 2008 年共识，对肺部 IFI 进行分类。
研究期间，2083 例血液病患者中有 236 例（11.3%）诊断为肺部 IFI，包括 41 例（17.4%）确诊、75 例（31.8%）可能确诊和 120 例（50.8%）可能病例。在 116 例确诊和可能的肺部 IFI 患者中，曲霉菌单独感染（n=90，77.6%）最为常见，其次是隐球菌单独感染（n=9，7.8%）和毛霉菌感染（n=4，3.4%）。肺部 IFI 患者的总发生率为每 100 患者年 5.9 例。发生率最高（每 100 患者年）见于急性髓性白血病患者（13.7），其次是急性淋巴细胞白血病患者（11.3）和骨髓增生异常综合征/严重再生障碍性贫血患者（6.7）。236 例肺部 IFI 患者中有 14 例（5.9%）在诊断为肺部 IFI 后 12 周内死亡。单因素分析显示，年龄较大（>65 岁）（P=0.034）、抗真菌治疗无反应（P<0.001）和入住重症监护病房（ICU）（P<0.001）是预后不良的预测因素。然而，只有入住 ICU 是 12 周死亡率的独立预后不良预测因素（P=0.022），这是基于多因素分析得出的。
急性白血病和骨髓增生异常综合征/严重再生障碍性贫血患者肺部 IFI 风险较高。
