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脂质体两性霉素B在血液病患者侵袭性真菌病挽救治疗中的临床疗效与安全性

[Clinical efficacy and safety of liposomal amphotericin B in the salvage treatment of invasive fungal disease in patients with hematological diseases].

作者信息

Wu Y B, Jiang S S, Wu Y X, Liu B, Jing Y T, Bao H Y, Ma X, Wu D P, Hu X H

机构信息

Department of Hematology, The Hospital of Suzhou Hongci Hematology, Suzhou 215000, China.

Department of Hematology, The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, National Clinical Research Center for Hematologic Diseases, Suzhou 215000, China.

出版信息

Zhonghua Xue Ye Xue Za Zhi. 2024 Jul 14;45(7):666-671. doi: 10.3760/cma.j.cn121090-20240228-00075.

Abstract

To investigate the efficacy and safety of liposomal amphotericin B (L-AmB) for the salvage treatment of invasive fungal disease (IFD) in patients with hematological diseases. Data were retrospectively collected from 80 patients with hematological issues treated with L-AmB between June 2023 and December 2023 after failure of previous antifungal therapy. Baseline patient information, clinical efficacy, and factors affecting the efficacy of L-AmB were analyzed by logistic regression. Moreover, adverse effects associated with L-AmB were evaluated. Among the 80 patients, 9 (11.2%) had proven IFD, 43 (53.8%) had probable IFD, and 28 (35.0%) had possible IFD. The efficacy rate of L-AmB salvage therapy for IFD was 77.5%, with a median daily dose of 3 (range: 1-5) mg·kg(-1)·d(-1) and a median dosing course of 14 (range: 8-25) days. Multivariate logistic regression analysis showed that the disease remission status (=4.337, 95% 1.167-16.122, =0.029) and duration of medication (=1.127, 95% 1.029-1.234, =0.010) were independent factors affecting the efficacy of L-AmB. The incidence of infusion reactions associated with L-AmB, including fever and chills, was 5.0%. The incidence of hypokalemia was 28.8% (predominantly grades 1-2), and the incidence of nephrotoxicity was 11.3% (predominantly grades 1-2) . L-AmB is safe and effective in the treatment of patients with IFD who are intolerant to or who have experienced no effect of previous antifungal therapy, with a low rate of adverse reactions.

摘要

探讨两性霉素B脂质体(L-AmB)对血液系统疾病患者侵袭性真菌病(IFD)挽救治疗的有效性和安全性。回顾性收集2023年6月至2023年12月间80例先前抗真菌治疗失败后接受L-AmB治疗的血液系统疾病患者的数据。通过逻辑回归分析患者基线信息、临床疗效及影响L-AmB疗效的因素。此外,评估与L-AmB相关的不良反应。80例患者中,9例(11.2%)确诊为IFD,43例(53.8%)可能为IFD,28例(35.0%)可能为IFD。L-AmB挽救治疗IFD的有效率为77.5%,中位日剂量为3(范围:1-5)mg·kg⁻¹·d⁻¹,中位给药疗程为14(范围:8-25)天。多因素逻辑回归分析显示,疾病缓解状态(=4.337,95% 1.167-16.122,=0.029)和用药时长(=1.127,95% 1.029-1.234,=0.010)是影响L-AmB疗效的独立因素。与L-AmB相关的输液反应发生率,包括发热和寒战,为5.0%。低钾血症发生率为28.8%(主要为1-2级),肾毒性发生率为11.3%(主要为1-2级)。L-AmB对不耐受或先前抗真菌治疗无效的IFD患者治疗安全有效,不良反应发生率低。

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