Lee Raeseok, Cho Sung-Yeon, Lee Dong-Gun, Choi Hyeah, Park Silvia, Cho Byung-Sik, Kim Yoo-Jin, Kim Hee-Je
Catholic Hematology Hospital, The Catholic University of Korea, Seoul 06591, Korea.
Department of Internal Medicine, Division of Infectious Diseases, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
Cancers (Basel). 2021 Dec 14;13(24):6285. doi: 10.3390/cancers13246285.
Although venetoclax (VEN)-based combination chemotherapy in patients with acute myeloid leukemia (AML) results in prolonged and profound neutropenia, data regarding infectious complications and antimicrobial prophylaxis are lacking. We investigated the infectious complications in 122 adult patients with AML under the same standard of care for prevention. The prophylaxis protocol was fluconazole 400 mg/d without antibacterial agents. The incidence of proven or probable invasive fungal infections (IFIs) was 6.6/100 cycles, and 22 patients (18.0%) were diagnosed (median, second cycle; interquartile range, 1-2). All IFIs were caused by and significantly influenced the overall mortality (odds ratio (OR), 2.737; 95% confidence interval (CI), 1.051-7.128; = 0.034). In the multivariate analysis, secondary or therapy-related AML was an independent risk factor for IFIs (OR, 3.859; 95% CI, 1.344-11.048, = 0.012). A total of 39 bloodstream infection (BSIs) episodes occurred in 35 patients (28.7%), with an incidence of 12.7/100 cycles. High-dose steroid administration within 90 days was associated with the occurrence of BSIs (OR, 7.474; 95% CI; 1.661-3.631, = 0.008), although BSIs themselves did not have an impact on the outcomes. Our findings suggest evidence for the need for mold-active antifungal agents as antifungal prophylaxis, rather than fluconazole, especially in patients with secondary or therapy-related AML.
尽管基于维奈克拉（VEN）的联合化疗可导致急性髓系白血病（AML）患者出现长期且严重的中性粒细胞减少，但关于感染并发症和抗菌预防的数据却很缺乏。我们在相同的预防标准治疗下，对122例成年AML患者的感染并发症进行了调查。预防方案为每日400毫克氟康唑，不使用抗菌药物。确诊或疑似侵袭性真菌感染（IFI）的发生率为6.6/100周期，22例患者（18.0%）被诊断为IFI（中位，第二周期；四分位间距，1 - 2）。所有IFI均由[此处原文缺失病原体信息]引起，并显著影响总体死亡率（优势比（OR），2.737；95%置信区间（CI），1.051 - 7.128；P = 0.034）。在多变量分析中，继发性或治疗相关AML是IFI的独立危险因素（OR，3.859；95% CI，1.344 - 11.048，P = 0.012）。35例患者（28.7%）共发生39次血流感染（BSI）事件，发生率为12.7/100周期。90天内使用高剂量类固醇与BSI的发生相关（OR，7.474；95% CI；1.661 - 3.631，P = 0.008），尽管BSI本身对结局没有影响。我们的研究结果表明，有证据显示需要使用具有抗霉菌活性的抗真菌药物进行抗真菌预防，而非氟康唑，尤其是对于继发性或治疗相关AML患者。
