Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, 315101, China.
BMC Infect Dis. 2022 May 15;22(1):465. doi: 10.1186/s12879-022-07442-y.
There is no consensus on the optimal secondary antifungal prophylaxis (SAP) regimen in patients receiving allogeneic hematopoietic stem cell transplantation (allo-HSCT). The purpose of this study was to evaluate the efficacy and safety of posaconazole oral suspension as secondary prophylaxis of invasive fungal disease (IFD) for allo-HSCT patients.
We retrospectively reviewed clinical data from prior IFD patients who received posaconazole oral suspension as systemic antifungal prophylaxis between June 2016 and January 2021 and have a follow-up period of 1 year after HSCT. The clinical outcomes of patients with a prior history of IFD (n = 30) and those without (n = 93) were compared.
The 1-year cumulative incidence of prophylaxis failure was 58.3% in the group with prior history of IFD and 41.6% in the group without a prior history of IFD (p = 0.459). The cumulative incidence of proven, probable or possible IFD within 1 year after allo-HSCT was 23.1% in the group with prior history of IFD and 14.1% in the group without prior history of IFD (p = 0.230). There was no significant difference between the cumulative incidence of proven or probable IFD within 1-year after allo-HSCT in the group with a prior history of IFD and the group without (p = 0.807). Multivariate logistic regression revealed cytomegalovirus disease as risk factor for post-transplantation IFD occurrence in posaconazole oral suspension prophylaxis. There was not a significant difference in overall survival between the patients with IFD history and those without (P = 0.559).
Our study support that allo-HSCT recipients with a prior history of IFD and normal GI absorption can choose posaconazole oral suspension as a safe and effective SAP option.
对于接受异基因造血干细胞移植（allo-HSCT）的患者，目前对于最佳的二线抗真菌预防（SAP）方案尚无共识。本研究旨在评估泊沙康唑口服混悬液作为 allo-HSCT 患者侵袭性真菌病（IFD）二级预防的疗效和安全性。
我们回顾性分析了 2016 年 6 月至 2021 年 1 月间接受泊沙康唑口服混悬液进行系统性抗真菌预防的既往 IFD 患者的临床数据，随访时间为 HSCT 后 1 年。比较了有既往 IFD 史（n=30）和无既往 IFD 史（n=93）患者的临床结局。
有既往 IFD 史组的 1 年累积预防失败率为 58.3%，无既往 IFD 史组为 41.6%（p=0.459）。allo-HSCT 后 1 年内确诊、可能或疑似 IFD 的累积发生率在有既往 IFD 史组为 23.1%，在无既往 IFD 史组为 14.1%（p=0.230）。allo-HSCT 后 1 年内有既往 IFD 史组和无既往 IFD 史组确诊或可能 IFD 的累积发生率无显著差异（p=0.807）。多变量 logistic 回归显示，巨细胞病毒病是泊沙康唑口服混悬液预防后移植后 IFD 发生的危险因素。有 IFD 史和无 IFD 史的患者总体生存率无显著差异（P=0.559）。
本研究支持 allo-HSCT 受者既往有 IFD 史且胃肠道吸收正常者，可选择泊沙康唑口服混悬液作为安全有效的 SAP 选择。
