University Hospital, Universidade Federal do Rio de Janeiro, Brazil.
University Hospital, Universidade Federal do Rio de Janeiro, Brazil; Grupo Oncoclínicas, Brazil.
Leuk Res. 2023 Aug;131:107341. doi: 10.1016/j.leukres.2023.107341. Epub 2023 Jun 14.
Invasive fungal disease (IFD) is a major complication in patients with acute myeloid leukemia (AML) receiving intensive induction chemotherapy, and the use of anti-mold prophylaxis is considered standard of care. On the other hand, the use of anti-mold prophylaxis in AML patients receiving less-intensive venetoclax-based regimens is not well established, basically because the incidence of IFD may not be high enough to justify primary antifungal prophylaxis. Furthermore, dose adjustments in venetoclax are needed because of drug interactions with azoles. Finally, the use of azoles is associated with toxicity, including liver, gastrointestinal and cardiac (QT prolongation) toxicity. In a setting of low incidence of invasive fungal disease, the number needed to harm would be higher than the number needed to treat. In this paper we review the risk factors for IFD in AML patients receiving intensive chemotherapeutic regimens, the incidence and risk factors for IFD in patients receiving hypomethylating agents alone, and in patients receiving less-intensive venetoclax-based regimens. We also discuss potential problems with the concomitant use of azoles, and present our perspective on how to manage AML patients receiving venetoclax-based regimens without primary antifungal prophylaxis.
侵袭性真菌病（IFD）是接受强化诱导化疗的急性髓系白血病（AML）患者的主要并发症，使用抗真菌预防治疗被认为是标准的治疗方法。另一方面，在接受强度较低的基于维奈托克的方案治疗的 AML 患者中，使用抗真菌预防治疗尚未得到充分证实，主要是因为 IFD 的发生率可能不足以证明需要进行预防性抗真菌治疗。此外，由于与唑类药物的药物相互作用，需要调整维奈托克的剂量。最后，唑类药物的使用与毒性相关，包括肝毒性、胃肠道毒性和心脏毒性（QT 延长）。在 IFD 发生率较低的情况下，需要治疗的人数会高于需要预防的人数。本文回顾了接受强化化疗方案的 AML 患者发生 IFD 的危险因素，单独接受低甲基化药物治疗的患者以及接受强度较低的基于维奈托克的方案治疗的患者发生 IFD 的发生率和危险因素。我们还讨论了同时使用唑类药物可能存在的问题，并提出了我们对如何管理不进行预防性抗真菌治疗的接受维奈托克治疗方案的 AML 患者的看法。
