title: Neutropenia and invasive fungal infection in patients with hematological malignancies treated with chemotherapy: a multicenter, prospective, non-interventional study in China.
abstract: In this study, we explored the relationship between neutropenia (absolute neutrophil count (ANC) <1,500/mm(3)) and invasive fungal infection (IFI) in Chinese patients who had hematological malignancies treated with chemotherapy. We conducted a multicenter, prospective, non-interventional study of consecutive patients with hematological malignancies undergoing chemotherapy in China and determined clinical characteristics of patients who developed neutropenia and IFI. The results indicated that for the 2,177 neutropenic patients, 88 (4.0 %) were diagnosed with IFI. We found that a high risk of IFI (P<0.05) is associated with male gender, non-remission of the primary disease, use of two or more broad-spectrum antibiotics, treatment with parenteral nutrition, presence of cardiovascular disease, history of IFI, and neutropenia. When the ANC was less than 1,000, 1,000∼500, 500∼100, and <100/mm(3), the incidence of IFI was 0.5, 5.2, 3.9, and 4.7 %, respectively (ANC>1,000/mm(3) versus other groups, P<0.001). When the ANC was less than 1,000, 500, or 100/mm(3) for 10 days or more, the incidence of IFI was 3.2 versus 6.1 % (P=0.0052), 3.5 versus 7.1 % (P=0.0021), and 3.1 versus 10.0 % (P<0.001). When the ANC was less than 100/mm(3), taking antifungal prophylaxis reduced the incidence of IFI (P<0.05). The IFI-attributable mortality rate was 11.7 %. In conclusion, Chinese patients with IFI, severe and prolonged neutropenia increases the incidence of IFI. The incidence of IFI associated with neutropenia was reduced when antifungal prophylaxis was given. IFI was associated with a significantly increased high mortality rate in hematological malignancy patients with neutropenia.
authors.affiliation: Department of Hematology, Guangzhou General Hospital of Guangzhou Military Command, 111 Liuhua Rd., Guangzhou, 510010, People's Republic of China.
authors.forename: Yonghua
authors.initials: Y
authors.lastname: Li
authors.forename: Wenning
authors.initials: W
authors.lastname: Xu
authors.forename: Zujun
authors.initials: Z
authors.lastname: Jiang
authors.forename: Yang
authors.initials: Y
authors.lastname: Gao
authors.forename: Yan
authors.initials: Y
authors.lastname: Pang
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.forename: Ling
authors.initials: L
authors.lastname: OuYang
authors.forename: Leqing
authors.initials: L
authors.lastname: Zhang
authors.forename: Zenghui
authors.initials: Z
authors.lastname: Liu
authors.forename: Yang
authors.initials: Y
authors.lastname: Wang
authors.forename: Yang
authors.initials: Y
authors.lastname: Xiao
authors.forename: Xiaojun
authors.initials: X
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D002681:China; D005260:Female; D019337:Hematologic Neoplasms / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology* / Q000517:prevention & control; D009503:Neutropenia / Q000150:complications*; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents