Hachem Ray, Batista Marjorie V, Kanj Souha S, El Zein Saeed, Haddad Sara, Jiang Ying, Mori Nobuyoshi, Vanderson Rocha, Chaftari Anne-Marie, Raad Issam
Department of Infectious Diseases, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Hospital das Clinicas da Faculdade de Medicina de Sao Paulo, Sao Paulo, Brazil.
Mediterr J Hematol Infect Dis. 2019 Jan 1;11(1):e2019003. doi: 10.4084/MJHID.2019.003. eCollection 2019.
Invasive aspergillosis (IA) is a life-threatening infection in immunocompromised patients. In this study, we compared the efficacy of voriconazole containing regimen vs non-voriconazole containing regimen in patients with IA.
In this retrospective study, we reviewed the medical records of all immunocompromised cancer patients diagnosed with proven or probable IA between February 2012 and March 2018. This trial included 26 patients from the American University of Beirut, Lebanon, 20 patients from Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, Brazil, and 10 patients from St. Luke's International Hospital Tokyo, Japan.
A total of 56 patients were analyzed. They were divided into 2 groups voriconazole containing regimen and non-voriconazole containing regimen (90% Amphotericin B based regimen). Both groups had similar characteristic, age, gender, and immunocompromised status. The majority of patients had underlying leukemia (63%), followed by lymphoma (20%), myeloma (16%) and other hematologic malignancy (1%). Antifungal primary therapy with voriconazole-containing regimen was associated with better response to treatment ( = 0.003). Survival analysis showed that primary therapy with a voriconazole containing regimen was significantly associated with improved survival ( =0.006). By multivariate logistic regression analysis, mechanical ventilation was a predictor of worse outcomes (poor response to therapy and increased mortality within 6 months), whereas primary treatment with voriconazole containing regimen was associated with improved outcomes including response to primary therapy (OR=18.1, =0.002) and 6-month mortality (OR=0.14, =0.011).
Based on international experience in immunocompromised cancer patients with IA, primary therapy with voriconazole-containing regimen is associated with improved response and survival compared with non-voriconazole amphotericin B based regimen.
侵袭性曲霉病（IA）是免疫功能低下患者的一种危及生命的感染。在本研究中，我们比较了含伏立康唑方案与不含伏立康唑方案对IA患者的疗效。
在这项回顾性研究中，我们查阅了2012年2月至2018年3月期间所有被诊断为确诊或疑似IA的免疫功能低下癌症患者的病历。该试验纳入了黎巴嫩贝鲁特美国大学的26名患者、巴西圣保罗大学医学院临床医院的20名患者以及日本东京圣路加国际医院的10名患者。
共分析了56例患者。他们被分为两组，含伏立康唑方案组和不含伏立康唑方案组（90%为基于两性霉素B的方案）。两组在特征、年龄、性别和免疫功能低下状态方面相似。大多数患者患有潜在白血病（63%），其次是淋巴瘤（20%）、骨髓瘤（16%）和其他血液系统恶性肿瘤（1%）。含伏立康唑方案的抗真菌初始治疗与更好的治疗反应相关（P = 0.003）。生存分析表明，含伏立康唑方案的初始治疗与生存率提高显著相关（P = 0 .006）。通过多因素逻辑回归分析，机械通气是预后较差的预测因素（治疗反应差和6个月内死亡率增加），而含伏立康唑方案的初始治疗与包括对初始治疗的反应（OR = 18.1，P = 0.002）和6个月死亡率（OR = 0.14，P = 0.011）在内的改善预后相关。
基于免疫功能低下癌症IA患者的国际经验，与不含伏立康唑的两性霉素B方案相比，含伏立康唑方案的初始治疗与更好的反应和生存相关。
