George Biju, Menon Hari, Bhurani Dinesh, Damodar Sharat, Apte Shashi, Seth Tulika, Sharma Ajay, Shyam Radhe, Malhotra Pankaj, Easow Jose, Lakshmi Kavitha M, Agrawal Narendra, Sengar Manju, Nataraj K S, Ahmed Rayaz, Sharma Sanjeevan, Khadwal Alka, Prakash Gaurav, Abraham Aby, Devasia Anup, Korula Anu, Mathews Vikram
1Christian Medical College, Vellore, India.
2Tata Memorial Hospital, Mumbai, India.
Indian J Hematol Blood Transfus. 2020 Jan;36(1):97-103. doi: 10.1007/s12288-019-01173-y. Epub 2019 Aug 26.
We performed a prospective multi-centre observational study to understand the incidence of IFI in patients with AML in India with use of anti-fungal prophylaxis. All patients with AML receiving either induction chemotherapy or salvage chemotherapy between November 2014 and February 2016 were included in this prospective observational study from 10 Indian centres. IFI was defined as per the revised EORTC-MSG criteria. Data on type of chemotherapy used, type of anti-fungal prophylaxis used, time to neutrophil recovery, incidence of IFI and survival were collected. Two hundred patients (118 male and 82 females) with a median age of 35 years (range: 2-66) were recruited. One hundred and eighty-six (93%) had newly diagnosed acute myeloid leukemia (AML) while 14 (7%) had relapsed disease. IFI occurred in 53 patients (26.5%) with proven or probable IFI occurring in 17 (8.5%). Use of posaconazole prophylaxis ( = 0.027) was the only factor found to be associated with a reduced incidence of IFI. The overall survival (OS) at 6 weeks and 3 months respectively was similar among patients who had IFI (83.0 ± 5.2%; 81.0 ± 5.4%) as compared to those without IFI (84.4 + 3.0%; 81.4 ± 3.2%). This prospective study reveals a high incidence of IFI in patients undergoing chemotherapy for AML in India. The use of posaconazole prophylaxis was associated with a significantly lower incidence of IFI. Optimal strategies to prevent IFI need to be studied.
我们开展了一项前瞻性多中心观察性研究，以了解在印度接受抗真菌预防治疗的急性髓系白血病（AML）患者中侵袭性真菌感染（IFI）的发生率。2014年11月至2016年2月期间，所有接受诱导化疗或挽救性化疗的AML患者均纳入了这项来自印度10个中心的前瞻性观察性研究。IFI根据修订后的欧洲癌症研究与治疗组织-侵袭性真菌感染协作组（EORTC-MSG）标准进行定义。收集了所使用化疗类型、抗真菌预防治疗类型、中性粒细胞恢复时间、IFI发生率和生存率的数据。招募了200例患者（118例男性和82例女性），中位年龄为35岁（范围：2 - 66岁）。其中186例（93%）为新诊断的急性髓系白血病（AML），14例（7%）为复发疾病。53例患者发生了IFI（26.5%），其中确诊或疑似IFI的有17例（8.5%）。使用泊沙康唑预防治疗（P = 0.027）是唯一与IFI发生率降低相关的因素。发生IFI的患者与未发生IFI的患者相比，6周和3个月时的总生存率（OS）分别相似（83.0±5.2%；81.0±5.4% vs 84.4 + 3.0%；81.4±3.2%）。这项前瞻性研究显示，在印度接受AML化疗的患者中IFI发生率很高。使用泊沙康唑预防治疗与IFI发生率显著降低相关。需要研究预防IFI的最佳策略。
