Secondary antifungal prophylaxis in hematological malignancies in a tertiary medical center.
To investigate the efficacy of secondary antifungal prophylaxis (SAP) in patients with hematological diseases, all medical records within two consecutive years were retrospectively reviewed. In all, 57 patients with a history of invasive fungal infections received 149 cycles of further therapy for their underlying hematological diseases. Logistic regression and recursive partitioning were used to discriminate high risk patients for failure of SAP. After a median follow-up period of 120 (12-1,080) days, 11 cases (7.4/100 cycles) experienced failure of SAP, including 5 cases during allo-SCT and 6 cases during chemotherapy, corresponding to cumulative incidence at 24.5%. Multivariate logistic regression revealed two risk factors for failure of SAP: use of high dose corticosteroid (OR 13.5, 95% CI 3.09-58.6, P = 0.0005) and duration of neutropenia ≥ 14 days (OR 7.47, 95% CI 1.69-32.9, P = 0.008). Recursive partitioning found that patients with these two risk factors were in high risk, with SAP failure rate as high as 50.0%. In conclusion, use of high dose corticosteroid and duration of neutropenia ≥ 14 days were risk factors of SAP failure. Patients with the two risk factors concurrently were in high risk and needed special concern.
Hematopoietic Stem Cell Transplantation Center, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.288 Nanjing Road, Tianjin, China.
Axia
A
Song
Dong-Lin
DL
Yang
Yong
Y
Huang
Er-Lie
EL
Jiang
Zhang-Song
ZS
Yan
Jia-Lin
JL
Wei
Mei
M
Wang
Qiao-Ling
QL
Ma
Yi
Y
He
Rong-Li
RL
Zhang
Wei-Hua
WH
Zhai
Si-Zhou
SZ
Feng
Ming-Zhe
MZ
Han
D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control*; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
D000935:Antifungal Agents