Infectious Disease Research Program, University Children's Hospital Münster, Münster, Germany.
Center for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany.
Mycoses. 2019 Oct;62(10):954-960. doi: 10.1111/myc.12968. Epub 2019 Aug 18.
Autologous hematopoietic stem cell transplantation (HSCT) carries risks of infectious morbidity. We analysed epidemiology and management burden associated with invasive fungal diseases (IFDs) in children and adolescents undergoing autologous HSCT.
In a retrospective, single-centre observational study, epidemiology and management burden associated with IFDs were analysed in all paediatric cancer patients who underwent autologous HSCT between 2005 and 2014. Clinical, radiographic and microbiological data were assessed up to 100 days post-transplant. The primary endpoint was the incidence of proven, probable and possible IFDs. Further endpoints included the use of systemic antifungal agents for prevention and management of IFDs; infectious and non-infectious comorbidities; and survival until day + 100.
Of 95 patients (median age: 8 years; r, 0.75-20) underwent 103 HSCT procedures for solid tumours (92) or lymphoma (11). Primary antifungal prophylaxis was administered in 49 procedures (47.5%). No single case of proven/probable IFD was diagnosed. Nine cases (8.7%) fulfilled criteria of possible pulmonary mould infection and received treatment for a median of 14 days (r, 7-35). In an additional 12 procedures, empiric antifungal therapy with mould active agents was given for a median of 8 days (r, 3-105). Microbiologically documented non-fungal infections were observed in 17 procedures, and five patients were transferred to the ICU. There was one death from biopsy documented toxic endothelial damage at day 83 post-transplant.
Autologous HSCT for solid tumours or lymphoma was associated with low morbidity from IFDs. However, utilisation of systemic antifungal agents for prevention and management of suspected IFDs was considerable.
自体造血干细胞移植（HSCT）存在感染发病率的风险。我们分析了接受自体 HSCT 的儿童和青少年侵袭性真菌病（IFD）的流行病学和管理负担。
在一项回顾性、单中心观察性研究中，分析了 2005 年至 2014 年间接受自体 HSCT 的所有儿科癌症患者的 IFD 流行病学和管理负担。临床、影像学和微生物学数据在移植后 100 天内进行评估。主要终点是确诊、可能和疑似 IFD 的发生率。其他终点包括用于预防和管理 IFD 的系统抗真菌药物的使用；感染和非感染合并症；以及存活至第+100 天。
95 例患者（中位年龄：8 岁；范围，0.75-20 岁）接受了 103 例实体瘤（92 例）或淋巴瘤（11 例）的 HSCT 治疗。49 例（47.5%）进行了单一抗真菌预防。未诊断出一例确诊/可能 IFD。9 例（8.7%）符合可能的肺部霉菌感染标准，并接受了中位数为 14 天（范围，7-35）的治疗。在另外 12 例中，给予了中位数为 8 天（范围，3-105）的具有霉菌活性的经验性抗真菌治疗。17 例观察到微生物学证实的非真菌感染，5 例患者转入 ICU。移植后第 83 天，有 1 例因活检证实毒性内皮损伤而死亡。
实体瘤或淋巴瘤的自体 HSCT 与 IFD 的发病率低相关。然而，用于预防和管理疑似 IFD 的系统抗真菌药物的使用量相当大。
