Division of Hematology/Oncology, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Division of Hematology/Oncology, Rhode Island Hospital, Lifespan Cancer Institute, Providence, RI, USA.
Support Care Cancer. 2021 Feb;29(2):707-712. doi: 10.1007/s00520-020-05535-5. Epub 2020 May 21.
Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in patients undergoing induction chemotherapy for acute myeloid leukemia (AML). In this patient population, antifungal prophylaxis (AP) has been associated with decreased incidence of IFIs and better survival. However, some centers have not adopted AP during induction chemotherapy for AML, as it is unclear whether AP improves outcomes in settings where the incidence of invasive mold infections is low. We retrospectively assessed the differences in clinical outcomes and resource utilization in patients undergoing 7 + 3 induction chemotherapy for AML, after implementing a policy of AP as part of a dedicated inpatient malignant hematology service (HS) at Rhode Island Hospital. Between January 1, 2007 and April 1, 2019, 56 patients with AML received AP during 7 + 3 induction chemotherapy and 52 patients did not, without significant differences in their baseline characteristics. Use of AP was associated with less proven or probable IFI (0% vs. 6%, P = 0.1) and lower all-cause in-hospital mortality (7% vs. 21%, P < 0.05), without significant increases in resource utilization or toxicities. Empiric and targeted antifungal therapies were more frequently started in the non-AP group (69%) than changed in the AP group (41%, P < 0.005). Having a dedicated inpatient malignant hematology service was also associated with improved outcomes. However, use of AP was associated with better survival (30-day post-induction survival log-rank P < 0.05), prior to the implementation of this clinical service as well, which is suggestive of an independent benefit from AP.
侵袭性真菌感染 (IFI) 是接受急性髓细胞性白血病 (AML) 诱导化疗患者发病率和死亡率的主要原因。在这一患者群体中，抗真菌预防 (AP) 与 IFI 发病率降低和生存改善相关。然而，一些中心在 AML 诱导化疗期间并未采用 AP，因为尚不清楚在侵袭性霉菌感染发生率较低的情况下，AP 是否能改善结局。我们回顾性评估了在罗德岛医院恶性血液病专科病房实施 AP 作为常规治疗后，接受 7+3 诱导化疗的 AML 患者的临床结局和资源利用差异。2007 年 1 月 1 日至 2019 年 4 月 1 日，56 例 AML 患者在 7+3 诱导化疗期间接受了 AP，52 例患者未接受 AP，两组患者的基线特征无显著差异。AP 组患者确诊或疑似 IFI 发生率（0% vs. 6%，P=0.1）和全因院内死亡率（7% vs. 21%，P<0.05）均较低，资源利用率或毒性无显著增加。非 AP 组中更频繁地开始经验性和靶向抗真菌治疗（69%），而 AP 组中更频繁地改变抗真菌治疗（41%，P<0.005）。设立恶性血液病专科病房也与改善结局相关。然而，即使在实施该临床服务之前，AP 也与更好的生存相关（诱导后 30 天生存对数秩 P<0.05），提示 AP 具有独立获益。
