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学科主题: 临床医学
题名:
Invasive fungal infection in patients receiving chemotherapy for hematological malignancy: a multicenter, prospective, observational study in China
作者: Sun, Yuqian1; Huang, He2; Chen, Jing3; Li, Jianyong4; Ma, Jun5; Li, Juan6; Liang, Yingmin7; Wang, Jianmin8; Li, Yan9; Yu, Kang10; Hu, Jianda11; Jin, Jie2; Wang, Chun12; Wu, Depei13; Xiao, Yang14; Huang, Xiaojun1
关键词: IFI ; Chemotherapy ; Hematological cancer ; Mortality ; Antifungal
刊名: TUMOR BIOLOGY
发表日期: 2015-02-01
DOI: 10.1007/s13277-014-2649-7
卷: 36, 期:2, 页:757-767
收录类别: SCI
文章类型: Article
WOS标题词: Science & Technology
类目[WOS]: Oncology
研究领域[WOS]: Oncology
关键词[WOS]: STEM-CELL TRANSPLANTATION ; POSACONAZOLE VS. FLUCONAZOLE ; CLINICAL-PRACTICE GUIDELINE ; ANTIFUNGAL THERAPY ; RISK-FACTORS ; NEUTROPENIC PATIENTS ; DISEASES ; EPIDEMIOLOGY ; PROPHYLAXIS ; SOCIETY
英文摘要:

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.

语种: 英语
项目资助者: Merck Sharp Dohme China
WOS记录号: WOS:000350478200035
Citation statistics:
内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/56425
Appears in Collections:北京大学第二临床医学院_血液科_期刊论文

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作者单位: 1.China Med Univ, Affiliated Hosp 1, Shenyang, Peoples R China
2.Fujian Med Univ, Union Hosp, Fuzhou, Peoples R China
3.First Peoples Hosp Shanghai, Shanghai, Peoples R China
4.Soochow Univ, Affiliated Hosp 1, Suzhou, Peoples R China
5.Shanghai Childrens Med Ctr, Shanghai, Peoples R China
6.Jiangsu Prov Hosp, Nanjing, Jiangsu, Peoples R China
7.Harbin Hematol Tumor Inst, Harbin, Peoples R China
8.Peking Univ, Inst Hematol, Peoples Hosp, Beijing Key Lab Hematopoiet Stem Cell Transplanta, Beijing 100871, Peoples R China
9.Zhejiang Univ, Sch Med, Affiliated Hosp 1, Hangzhou 310003, Zhejiang, Peoples R China
10.Sun Yat Sen Univ, Affiliated Hosp 1, Guangzhou 510275, Guangdong, Peoples R China
11.Fourth Mil Med Univ, Tangdu Hosp, Xian 710032, Peoples R China
12.Second Mil Med Univ, Changhai Hosp, Shanghai, Peoples R China
13.Wenzhou Med Coll, Affiliated Hosp 1, Wenzhou, Peoples R China
14.PLA, Gen Hosp, Guangzhou Mil Command, Guangzhou, Guangdong, Peoples R China

Recommended Citation:
Sun, Yuqian,Huang, He,Chen, Jing,et al. Invasive fungal infection in patients receiving chemotherapy for hematological malignancy: a multicenter, prospective, observational study in China[J]. TUMOR BIOLOGY,2015,36(2):757-767.
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