Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil; Tumour Biomarkers and Osteoimmunology Laboratory, Av. Pará - 1720 - Block 6T, Room 07 - District Umuarama, Uberlândia, MG, Brazil.
Cancer Epidemiol. 2024 Aug;91:102593. doi: 10.1016/j.canep.2024.102593. Epub 2024 May 29.
Acute myeloid leukemia patients are at high risk for infections, which contribute to increased mortality rates of up to 70%. The use of antimicrobial prophylaxis has been shown to significantly lower rates of infection. Therefore, this retrospective study aimed to evaluate the effect of two agents that showed effective results in the literature, levofloxacin and fluconazole, as prophylaxis strategies in AML patients.
A total of 85 AML patients' medical records treated with a 7+3 induction chemotherapy protocol in the Cancer Hospital of Uberlândia from 2017 to 2021 were screened and their data was collected. Within these patients, groups for analysis were created based on whether the acting physician included an antibacterial or antifungal prophylaxis protocol during induction. Contingency tables with χ² and odds ratio tests were realized to verify associations between prophylaxis and infection. Additionally, Kaplan-Meier curves with Cox regression were developed to analyze survival.
The use of prophylaxis with either fluconazole or levofloxacin did not lower rates of infection, as those who with prophylaxis did not demonstrate significant differences when compared to those without (20.3-29.7%, and 12.3-23.3%, respectively). Patients who suffered a bacterial infection during induction were shown to have lower overall survival, with a similar trend seen in fungal infections.
Bacterial and fungal infections were associated with higher rates of induction mortality and lower overall survival, and prophylaxis using fluconazole and levofloxacin did not present any significant difference in preventing these infections in this study, contrasting results found in the literature. The individuality of each treatment center should be taken into consideration and future studies should be realized to better determine the most effective methods and agents for prophylaxis.
急性髓系白血病患者感染风险高，死亡率高达 70%。抗菌预防已被证明可显著降低感染率。因此，本回顾性研究旨在评估两种在文献中显示有效结果的药物，左氧氟沙星和氟康唑，作为 AML 患者预防策略的效果。
筛选了 2017 年至 2021 年在 Uberlândia 癌症医院接受 7+3 诱导化疗方案治疗的 85 名 AML 患者的病历，并收集了他们的数据。在这些患者中，根据诱导期主治医生是否包含抗菌或抗真菌预防方案，创建了分析组。通过 χ²和优势比检验实现了列联表，以验证预防与感染之间的关联。此外，还开发了 Kaplan-Meier 曲线和 Cox 回归来分析生存情况。
使用氟康唑或左氧氟沙星预防均未降低感染率，因为与未预防的患者相比，预防组的感染率无显著差异（分别为 20.3-29.7%和 12.3-23.3%）。在诱导期间发生细菌感染的患者总体生存率较低，真菌感染也有类似趋势。
细菌和真菌感染与诱导死亡率较高和总体生存率较低相关，氟康唑和左氧氟沙星预防在本研究中并未显示在预防这些感染方面有任何显著差异，与文献中的结果相反。应考虑每个治疗中心的个体差异，并应开展未来的研究，以更好地确定预防的最有效方法和药物。
