Ross Justine Abella, Lee Brian, Ma Huiyan, Tegtmeier Bernard, Nanayakkara Deepa, Dickter Jana, Spielberger Ricardo, Smith Eileen, Pullarkat Vinod, Forman Stephen J, Taplitz Randy, Nakamura Ryotaro, Al Malki Monzr, Dadwal Sanjeet Singh
Department of Pharmacy, City of Hope National Medical Center, Duarte, California, USA.
Division of Biostatistics, Department of Computational and Quantitative Medicine, Beckman Research Institute of City of Hope, Duarte, California, USA.
Open Forum Infect Dis. 2024 Jul 23;11(8):ofae409. doi: 10.1093/ofid/ofae409. eCollection 2024 Aug.
Continuing antifungal prophylaxis (AFPx) to prevent invasive mold infections (IMIs) in recipients of allogeneic hematopoietic cell transplantation (alloHCT) after primary hospital discharge from alloHCT admission varies among transplant centers despite recommendations to continue prophylaxis through day +75. Characteristics driving AFPx prescribing at hospital discharge and outcomes are unknown.
In this retrospective analysis, we reviewed patients continuing AFPx vs no AFPx at hospital discharge. We included patients with a hospital stay ≥7 days and ≤40 days. We excluded patients with a history of IMI prior to alloHCT, new IMI during admission, or death prior to discharge. Our primary objective was incidence of probable or proven IMI per the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Our secondary objectives were nonrelapse mortality at day +100, overall survival at day +100, and characteristics driving AFPx discontinuation at hospital discharge.
Of the 430 patients identified, 387 met inclusion criteria. At discharge, 56% (217/387) continued AFPx, and 44% (170/387) had no AFPx. At day +100, 3 probable IMI cases occurred in the group with continued AFPx vs 1 probable IMI case in the no-AFPx group (no proven IMI). Univariate analysis showed no difference in cumulative incidence of probable IMI ( = .440), nonrelapse mortality ( = .072), and overall survival ( = .855) between groups. Multivariable logistic regression demonstrated that patients were less likely to continue AFPx if they had a diagnosis other than acute myeloid leukemia, a length of stay ≤30 days, acute graft-vs-host disease grade 0 or 1, and corticosteroid use ≤5 days.
There was no difference in probable IMI at day +100 after alloHCT based on continuing vs discontinuing AFPx at hospital discharge after alloHCT admission supporting a risk-adapted prophylaxis approach.
尽管有建议在异基因造血细胞移植（alloHCT）入院后至+75天持续进行抗真菌预防（AFPx）以预防侵袭性霉菌感染（IMIs），但各移植中心在alloHCT初次出院后继续进行抗真菌预防的情况各不相同。导致出院时开具AFPx的因素及预后尚不清楚。
在这项回顾性分析中，我们对出院时继续使用AFPx与未使用AFPx的患者进行了回顾。我们纳入了住院时间≥7天且≤40天的患者。我们排除了alloHCT之前有IMI病史、住院期间新发IMI或出院前死亡的患者。我们的主要目标是根据欧洲癌症研究与治疗组织和真菌病研究组教育与研究联盟的标准确定可能或确诊的IMI发生率。我们的次要目标是+100天时的非复发死亡率、+100天时的总生存率，以及导致出院时停用AFPx的因素。
在确定的430例患者中，387例符合纳入标准。出院时，56%（217/387）继续使用AFPx，44%（170/387）未使用AFPx。在+100天时，继续使用AFPx的组中有3例可能的IMI病例，而未使用AFPx的组中有1例可能的IMI病例（无确诊的IMI）。单因素分析显示，两组之间可能的IMI累积发生率（P = 0.440）、非复发死亡率（P = 0.072）和总生存率（P = 0.855）无差异。多变量逻辑回归表明，如果患者诊断不是急性髓系白血病、住院时间≤30天、急性移植物抗宿主病0级或1级以及使用皮质类固醇≤5天，则继续使用AFPx的可能性较小。
在alloHCT入院后出院时继续或停止AFPx，对alloHCT后+100天时可能的IMI发生率没有差异，这支持了一种风险适应性预防方法。
