| Title | Invasive fungal infection in patients receiving chemotherapy for hematological malignancy: a multicenter, prospective, observational study in China |
| Authors | Sun, Yuqian Huang, He Chen, Jing Li, Jianyong Ma, Jun Li, Juan Liang, Yingmin Wang, Jianmin Li, Yan Yu, Kang Hu, Jianda Jin, Jie Wang, Chun Wu, Depei Xiao, Yang Huang, Xiaojun |
| Affiliation | Peking Univ, Inst Hematol, Peoples Hosp, Beijing Key Lab Hematopoiet Stem Cell Transplanta, Beijing 100871, Peoples R China. Zhejiang Univ, Sch Med, Affiliated Hosp 1, Hangzhou 310003, Zhejiang, Peoples R China. Shanghai Childrens Med Ctr, Shanghai, Peoples R China. Jiangsu Prov Hosp, Nanjing, Jiangsu, Peoples R China. Harbin Hematol Tumor Inst, Harbin, Peoples R China. Sun Yat Sen Univ, Affiliated Hosp 1, Guangzhou 510275, Guangdong, Peoples R China. Fourth Mil Med Univ, Tangdu Hosp, Xian 710032, Peoples R China. Second Mil Med Univ, Changhai Hosp, Shanghai, Peoples R China. China Med Univ, Affiliated Hosp 1, Shenyang, Peoples R China. Wenzhou Med Coll, Affiliated Hosp 1, Wenzhou, Peoples R China. Fujian Med Univ, Union Hosp, Fuzhou, Peoples R China. First Peoples Hosp Shanghai, Shanghai, Peoples R China. Soochow Univ, Affiliated Hosp 1, Suzhou, Peoples R China. PLA, Gen Hosp, Guangzhou Mil Command, Guangzhou, Guangdong, Peoples R China. Peking Univ, Inst Hematol, Peoples Hosp, Beijing Key Lab Hematopoiet Stem Cell Transplanta, 11 Xizhimen South St, Beijing 100871, Peoples R China. |
| Keywords | IFI Chemotherapy Hematological cancer Mortality Antifungal STEM-CELL TRANSPLANTATION POSACONAZOLE VS. FLUCONAZOLE CLINICAL-PRACTICE GUIDELINE ANTIFUNGAL THERAPY RISK-FACTORS NEUTROPENIC PATIENTS DISEASES EPIDEMIOLOGY PROPHYLAXIS SOCIETY |
| Issue Date | 2015 |
| Publisher | tumor biology |
| Citation | TUMOR BIOLOGY.2015,36,(2),757-767. |
| Abstract | This stud y examined the epidemiology, risk factors, management, and outcome of invasive fungal infection (IFI) in patients receiving chemotherapy for hematological malignancy in China. IFI risk factors were analyzed using univariate analysis and multivariate logistic regression. In total, 4,192 patients receiving 4,889 chemotherapy courses were enrolled [mean age 40.7 years, 58.4 % male, 16.9 % children (< 18 years)]. The most common hematological diseases were acute myeloid leukemia (AML, 28.5 %), non-Hodgkin lymphoma (NHL, 26.3 %), and acute lymphoblastic leukemia (ALL, 20.2 %). Severe neutropenia (absolute neutrophil count [ANC] < 500/mm(3)) occurred after one third (1,633/4,889, 33.4 %) of chemotherapy courses. Incidence of proven/probable IFI was 2.1 % per chemotherapy course and higher in patients with myelodysplastic syndrome (MDS, 4.94 %), acute hyperleukocytic leukemia (AHL, 4.76 %), AML (3.83 %), or induction chemotherapy. Risk factors included ANC < 500/mm(3) [odds ratio (OR) 3.60], AML or MDS (OR 1.97), induction chemotherapy (OR 2.58), previous IFI (OR 3.08), and being male (OR 1.74). Antifungal agents, prescribed in one quarter (1,211/4,889, 24.8 %) of chemotherapy courses, included primary/secondary prophylaxis (n = 827, 16.9 %) and/or treatment (n = 655, 13.4 %; 86.9 % triazoles), which was empirical (84.3 %), pre-emptive (8.6 %), or targeted (7.1 %). Overall mortality following each chemotherapy course (1.5 %) increased in proven/probable (11.7 %) and possible IFI (8.2 %). In summary, IFI was more common in MDS, AHL, AML, or induction chemotherapy, and substantially increased mortality. Neutropenic patients receiving induction chemotherapy for AML or MDS and those with previous IFI were at particular risk. Antifungal prophylaxis showed an independent protective effect but was not commonly used, even in high-risk patients. By contrast, empiric antifungals were widely used. |
| URI | http://hdl.handle.net/20.500.11897/159128 |
| ISSN | 1010-4283 |
| DOI | 10.1007/s13277-014-2649-7 |
| Indexed | SCI(E) PubMed |
| Appears in Collections: | 医学部待认领 |
