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学科主题: 临床医学
题名:
Epidemiology, Management, and Outcome of Invasive Fungal Disease in Patients Undergoing Hematopoietic Stem Cell Transplantation in China: A Multicenter Prospective Observational Study
作者: Sun, Yuqian1; Meng, Fanyi2; Han, Mingzhe3,4; Zhang, Xi5; Yu, Li; Huang, He7; Wu, Depei8; Ren, Hanyun9; Wang, Chun10; Shen, Zhixiang11; Ji, Yu1; Huang, Xiaojun1
关键词: Allogeneic ; Autologous ; China ; Fungal infection ; Stem cells ; Transplant
刊名: BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
发表日期: 2015-06-01
DOI: 10.1016/j.bbmt.2015.03.018
卷: 21, 期:6, 页:1117-1126
收录类别: SCI
文章类型: Article
WOS标题词: Science & Technology
类目[WOS]: Hematology ; Immunology ; Transplantation
研究领域[WOS]: Hematology ; Immunology ; Transplantation
关键词[WOS]: HEMATOLOGICAL MALIGNANCIES ; RISK-FACTORS ; ANTIFUNGAL THERAPY ; MOLD INFECTIONS ; SINGLE-CENTER ; RECIPIENTS ; ASPERGILLOSIS ; RECOMMENDATIONS ; SURVEILLANCE ; GUIDELINE
英文摘要:

The China Assessment of Antifungal Therapy in Hematological Disease study, the first large-scale observational study of invasive fungal disease (IFD) in China, enrolled 1401 patients undergoing hematopoietic stem cell transplantation (HSCT) (75.2% allogeneic and 24.8% autologous) at 31 hospitals across China. The overall incidence of proven or probable IFD was 7.7% (108 of 1401); another 266 cases (19.0%) were possible IFD. After allogeneic or autologous HSCT, the incidence of proven/probable IFD was 8.9% (94 of 1053) and 4.0% (14 of 348), respectively. Some cases (14 of 108) developed during conditioning before transplantation. The cumulative incidence of proven/probable IFD increased steeply in the first month after transplantation and after 6 months, the incidence was significantly higher in allogeneic than it was in autologous transplant recipients (9.2% versus 3.5%; P = .001) and when stem cells were derived from cord blood or bone marrow and peripheral blood (P = .02 versus other sources). Independent risk factors for proven/probable IFD in allogeneic HSCT were diabetes, HLA-matched unrelated donor, prolonged severe neutropenia (absolute neutrophil count > 500/mm(3) for >14 days), and immunosuppressants (odds ratio, 2.0 to 3.4 for all). Antifungal prophylaxis Was independently protective (P = .01). Previous IFD and prolonged severe neutropenia were significant independent risk factors among autologous transplantation patients (P<.01, P = .04, respectively). In total, 1175 (83.9%) patients received antifungal prophylaxis (91.6% triazoles) and 514 (36.7%) were treated in the hospital with therapeutic antifungals (89.1% triazoles; median 27 days). Empirical, pre-emptive, and targeted antifungals were used in 82.3%, 13.6%, and 4.1% of cases, respectively. Overall mortality (13.4%; 188 deaths) was markedly higher in patients with proven (5 of 16; 31.3%), probable (20 of 92; 21.7%), or possible (61 of 266; 22.9%) IFD; allogeneic (171 of 1053:16.2%) rather than autologous (17 of 348; 4.9%) HSCT and was significantly higher in patients receiving pre-emptive (18.6%) rather than empirical (6.1%) or targeted (9.5%) antifungal therapy (P = .002). Improvements in the selection and timing of prophylactic antifungals would be welcome. Health care providers should remain alert to the increased risk of IFD and associated mortality in allogeneic HSCT recipients and the ongoing risk of IFD even after discharge from the hospital. (C) 2015 American Society for Blood and Marrow Transplantation.

语种: 英语
项目资助者: Merck Sharp Dohme China
WOS记录号: WOS:000354667900020
Citation statistics:
内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/61316
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.Peking Univ, Peoples Hosp, Inst Hematol, Beijing Key Lab Hematopoiet Stem Cell Transplanta, Beijing, Peoples R China
2.Nanfang Med Univ, Nanfang Hosp, Guangzhou, Guangdong, Peoples R China
3.Chinese Acad Med Sci, Inst Hematol, Tianjin, Peoples R China
4.Chinese Acad Med Sci, Blood Dis Hosp, Tianjin, Peoples R China
5.Third Mil Med Univ, Affiliated Hosp 2, Xinqiao Hosp, Chongqing, Peoples R China
6.Chinese Peoples Liberat Army Gen Hosp, Hosp 301, Beijing 100853, Peoples R China
7.Zhejiang Univ, Sch Med, Affiliated Hosp 1, Hangzhou 310003, Zhejiang, Peoples R China
8.Soochow Univ, Affiliated Hosp 1, Suzhou, Peoples R China
9.Peking Univ, Hosp 1, Beijing 100871, Peoples R China
10.First Peoples Hosp Shanghai, Shanghai, Peoples R China
11.Shanghai Jiao Tong Univ, Sch Med, Rui Jin Hosp, Shanghai 200030, Peoples R China

Recommended Citation:
Sun, Yuqian,Meng, Fanyi,Han, Mingzhe,et al. Epidemiology, Management, and Outcome of Invasive Fungal Disease in Patients Undergoing Hematopoietic Stem Cell Transplantation in China: A Multicenter Prospective Observational Study[J]. BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION,2015,21(6):1117-1126.
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