Department of Hematology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Mycoses. 2023 Jun;66(6):505-514. doi: 10.1111/myc.13576. Epub 2023 Feb 23.
To reduce the risk of invasive aspergillosis (IA), air purification by high-efficiency particulate air filtration and laminar air flow (HEPA/LAF) is standard of care in allogeneic blood stem cell transplantation. Its use in non-transplant haematological patients is inconsistent.
We sought to assess the incidence and outcome of pulmonary IA in non-transplant patients with life-threatening neutropenia by comparing an ambient air hospitalisation period (2008-2011) with a subsequent HEPA/LAF hospitalisation period (2012-2014).
We compared 204 consecutive patients with acute myeloid leukaemia, acute lymphoblastic leukaemia or aplastic anaemia completing 534 neutropenia-related hospitalisations under ambient air conditions with 126 such patients completing 437 neutropenia-related hospitalisations under HEPA/LAF conditions. IA was defined using the 2008 EORTC/MSG criteria.
Within a 7-year study period, we observed one 'proven', three 'probable' and 73 'possible' IAs, most often during acute leukaemia remission induction. Their frequency rose with increasing duration of life-threatening neutropenia (1-10 days, 1.8%; >40 days, 35.2%) and concomitant severe anaemia (0 days, 3.2%; >20 days, 31.0%). Multiple logistic regression revealed a strong correlation between IA incidence and hospitalisation under HEPA/LAF conditions (odds ratio [OR], 0.368 [95% confidence interval, 0.207-0.654]; p < .001) and duration of neutropenia (OR, 1.043 [1.023-1.062] per day; p < .001) and anaemia (OR, 1.044 [1.008-1.081] per day; p = .016). IA-associated fatal outcomes were non-significantly reduced under HEPA/LAF (OR, 0.077 [0.005-1.151]; p = .063). The protective effect of HEPA/LAF was not seen under posaconazole prophylaxis (OR, 0.856 [0.376-1.950]; p = .711).
Implementation of HEPA/LAF was associated with a significant reduction in neutropenia-related IA in non-transplant haematological patients.
为了降低侵袭性曲霉病（IA）的风险，在异基因造血干细胞移植中，高效微粒空气过滤和层流空气（HEPA/LAF）空气净化是标准的治疗方法。在非移植血液系统患者中的应用并不一致。
我们通过比较环境空气住院期（2008-2011 年）和随后的 HEPA/LAF 住院期（2012-2014 年），评估生命危象中性粒细胞减少症非移植患者中肺部 IA 的发生率和结局。
我们比较了 204 例连续急性髓性白血病、急性淋巴细胞白血病或再生障碍性贫血患者，他们在环境空气中完成了 534 次中性粒细胞减少相关住院治疗，而 126 例患者在 HEPA/LAF 条件下完成了 437 次中性粒细胞减少相关住院治疗。IA 采用 2008 年 EORTC/MSG 标准定义。
在 7 年的研究期间，我们观察到 1 例“确诊”、3 例“可能”和 73 例“可能”IA，最常见于急性白血病缓解诱导期。它们的发生率随着危及生命的中性粒细胞减少症的持续时间增加而升高（1-10 天，1.8%；>40 天，35.2%）和同时发生严重贫血（0 天，3.2%；>20 天，31.0%）。多因素逻辑回归显示，IA 发生率与 HEPA/LAF 条件下的住院治疗（优势比[OR]，0.368[95%置信区间，0.207-0.654]；p<0.001）和中性粒细胞减少症（OR，1.043[1.023-1.062]每天；p<0.001）和贫血（OR，1.044[1.008-1.081]每天；p=0.016）的持续时间之间存在很强的相关性。在 HEPA/LAF 下，IA 相关的致命结局显著降低（OR，0.077[0.005-1.151]；p=0.063）。在泊沙康唑预防治疗下，HEPA/LAF 的保护作用并不明显（OR，0.856[0.376-1.950]；p=0.711）。
在非移植血液系统患者中实施 HEPA/LAF 与中性粒细胞减少症相关 IA 的显著减少相关。
