Pei R Z, Lu Y, Zhang P S, Liu X H, Chen D, Du X H, Sha K Y, Li S Y, Cao J J, Chen L G, Zhuang X X, Tang S H
Department of Hematology, Ningbo Yinzhou People's Hospital, Ningbo 315040, Zhejiang Province, China.
Zhonghua Nei Ke Za Zhi. 2020 Mar 1;59(3):213-217. doi: 10.3760/cma.j.issn.0578-1426.2020.03.008.
To investigate the breakthrough incidence of invasive fungal disease(IFD) and side effects of posaconazole as primary prophylaxis during induction chemotherapy for acute myeloid leukemia(AML). A total of 206 newly diagnosed AML patients admitted to our department during January 2016 and December 2018 were enrolled in the study. Exclusive criteria were as followings including patients diagnosed as acute promyelocytic leukemia; those who received intravenous antifungal therapy after admission or had history of IFD one month before induction chemotherapy, or those with functional insufficiency of vital organs and those older than 65. Forty-seven patients received posaconazole (posaconazole group), 61 cases received voriconazole (voriconazole group) and 98 cases did not receive any prophylaxis (control group) during induction chemotherapy. Prophylactic efficacy and safety between posaconazole and voriconazole were compared. During induction chemotherapy, five possible cases of IFD occurred in posaconazole group (10.6%); while 11 cases (18.0%) were in voriconazole group including 7 possible, 3 probable and 1 proven. Thirty-five cases (35.7%) in control group were diagnosed as IFD including 19 possible, 11 probable and 5 proven ones. The incidences of IFD in posaconazole and voriconazole group were significantly lower than that in control group (0.05). The difference of posaconazole group and voriconazole group was not significant (0.05). The reported adverse events in posaconazole group were significantly lower than those in voriconazole group [12.8%(6/47) vs. 32.8%(20/61), 0.05]. Posaconazole and voriconazole decrease IFD as primary prophylaxis during induction chemotherapy in patients with AML. The prophylactic effect of IFD with posaconazole is similar as voriconazole, but posaconazole shows better safety.
探讨泊沙康唑作为急性髓系白血病（AML）诱导化疗期间一级预防侵袭性真菌病（IFD）的突破发生率及副作用。选取2016年1月至2018年12月期间收治于我科的206例新诊断AML患者纳入研究。排除标准如下：包括诊断为急性早幼粒细胞白血病的患者；入院后接受静脉抗真菌治疗或诱导化疗前1个月有IFD病史者，或重要器官功能不全者以及年龄大于65岁者。47例患者在诱导化疗期间接受泊沙康唑治疗（泊沙康唑组），61例接受伏立康唑治疗（伏立康唑组），98例未接受任何预防措施（对照组）。比较泊沙康唑和伏立康唑之间的预防效果及安全性。诱导化疗期间，泊沙康唑组发生5例可能的IFD（10.6%）；伏立康唑组发生11例（18.0%），包括7例可能的、3例很可能的和1例确诊的。对照组35例（35.7%）被诊断为IFD，包括19例可能的、11例很可能的和5例确诊的。泊沙康唑组和伏立康唑组的IFD发生率显著低于对照组（P<0.05）。泊沙康唑组和伏立康唑组之间差异无统计学意义（P>0.05）。泊沙康唑组报告的不良事件显著低于伏立康唑组[12.8%（6/47）对32.8%（20/61），P<0.05]。泊沙康唑和伏立康唑作为AML患者诱导化疗期间的一级预防可降低IFD。泊沙康唑预防IFD的效果与伏立康唑相似，但泊沙康唑安全性更好。
