Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland.
Bone Marrow Transplant Unit, Division of Hematology, University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Mycoses. 2022 Nov;65(11):1061-1067. doi: 10.1111/myc.13496. Epub 2022 Jul 25.
Limited data exist to describe end-of-treatment (EOT) parameters of antifungal therapy for invasive mould infections (IMI).
In a 10-year cohort of consecutive adult allogeneic haematopoietic cell transplant recipients with proven/probable IMI, we describe treatment duration and patient profile at EOT.
There were 61 patients with 66 proven/probable IMI identified: 47/66 (71%) invasive aspergillosis (IA), 11/66 (17%) mucormycosis, and 8/66 (12%) other-IMI. Excluding 5 (8%) patients lost to follow-up, treatment was prematurely discontinued due to death or palliative care in 29/56 (51.8%) patients. Antifungal treatment was completed in 27 (48.2%) patients, for a median duration of 280 days (IQR: 110, 809): 258 (IQR: 110, 1905) and 307.5 (99, 809) days in IA and non-IA IMI, respectively. Treatment was continued after 90 and 180 days in 43/56 (76.8%) and 30/56 (53.6%) patients, respectively. At EOT, most patients were not neutropenic (ANC: 2.12 G/L, IQR: 0.04, 5.3), with CD4+ counts at 99 cells/μl (IQR: 0, 759) and immunoglobulins at 5.6 g/L (IQR: 2.3, 10.6). Most patients (16/27, 59.3%) were not receiving steroids at EOT, while 14/27 (53.9%) were on another type of immunosuppression. Amongst 15 patients with imaging at EOT, 12 (80%) had complete/partial radiologic response. Any chart documentation or an infectious disease consultation on treatment discontinuation was observed in 12/56 (21%) and 11/56 (20%) patients, respectively.
Long treatment courses are observed in patients with IMI, due to prolonged immunosuppression. Although immune reconstitution and radiological response were frequently observed at EOT, consistent documentation of treatment discontinuation based on well-defined parameters is lacking.
目前关于侵袭性霉菌感染（IMI）的抗真菌治疗结束（EOT）参数的数据有限。
在一项连续 10 年的成人异基因造血细胞移植受者确诊/疑似 IMI 的队列研究中，我们描述了 EOT 时的治疗持续时间和患者特征。
共发现 61 例 66 例确诊/疑似 IMI：47/66（71%）侵袭性曲霉菌病（IA），11/66（17%）毛霉菌病，8/66（12%）其他 IMI。排除 5 例（8%）失访患者，56 例（51.8%）患者因死亡或姑息治疗而提前停止治疗。27 例（48.2%）患者完成了抗真菌治疗，中位治疗持续时间为 280 天（IQR：110，809）：IA 和非 IA IMI 分别为 258（IQR：110，1905）和 307.5（99，809）天。在 EOT 时，43/56（76.8%）和 30/56（53.6%）患者分别在 90 和 180 天后继续治疗。在 EOT 时，大多数患者无中性粒细胞减少症（ANC：2.12 G/L，IQR：0.04，5.3），CD4+计数为 99 个细胞/μl（IQR：0，759），免疫球蛋白为 5.6 g/L（IQR：2.3，10.6）。16/27（59.3%）名 EOT 时未接受类固醇治疗，而 14/27（53.9%）患者正在接受另一种类型的免疫抑制治疗。在 15 例 EOT 时进行影像学检查的患者中，12 例（80%）有完全/部分放射学反应。在 56 例患者中，有 12 例（21%）和 11 例（20%）分别有 EOT 时的治疗中断的任何图表记录或传染病会诊。
由于长期免疫抑制，IMI 患者的治疗疗程较长。尽管 EOT 时经常观察到免疫重建和放射学反应，但缺乏基于明确参数的治疗中断的一致记录。
