title: Epidemiology and treatment of invasive fungal diseases in patients with multiple myeloma: findings from a multicenter prospective study from China.
abstract: The aim of this study is to investigate the epidemiology, diagnosis, treatment and risk factors of multiple myeloma patients with invasive fungi disease (IFD) in China. We analyzed multiple myeloma (MM) patients receiving chemotherapy in a prospective multicenter study. Basic characteristics, the diagnosis, and treatment of IFD were recorded. A total of 395 MM patients were enrolled, who received a total of 443 chemotherapy courses. Among them, 17 IFDs were diagnosed during one chemotherapy course. Fourteen of these were possible IFD and 3 were probable IFD. Ten of the 14 patients with possible IFD had lung infection. Thirty eight (8.6 %) patients received antifungal prophylaxis, and 47.4 % of them were administered with fluconazole. Patients who had a history of IFD or underwent a combined therapy with two antibiotics for over 7 days and with a history of granulocytopenia or ductus venosus insertion were more likely to be treated with antifungal prophylaxis. All of first-line antifungal therapies were monotherapy. Eleven (84.6 %) cases were treated with azoles. The median time of initial antifungal therapy was 8 days. The general condition of two patients with probable IFD and 10 patients (90.9 %) with possible IFD improved, while 1 patient with possible IFD died. Multivariate analysis revealed that history of IFD is an independent risk factor of IFD. The present multicenter study suggests that the incidence of IFD per chemotherapy courses in MM patients is 3.8 % and most patients are labelled as having possible IFD. Fluconazole is the most common antifungal agent for prophylaxis and voriconazole for therapeutic treatment. Previous IFD is a probable independent risk factor of IFD in MM patients receiving chemotherapy.
authors.affiliation: Department of Hematology, The First Affiliated Hospital, SunYat-sen University, No. 58, Zhongshan Er Road, Guangzhou, 510080, People's Republic of China.
authors.forename: Junru
authors.initials: J
authors.lastname: Liu
authors.affiliation: The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, People's Republic of China.
authors.forename: He
authors.initials: H
authors.lastname: Huang
authors.affiliation: The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
authors.forename: Lin
authors.initials: L
authors.lastname: Liu
authors.affiliation: Jiangsu Province Hospital, Nanjing, People's Republic of China.
authors.forename: Jianyong
authors.initials: J
authors.lastname: Li
authors.affiliation: The Second Affiliated Hospital of China Medical University, Shengjing Hospital, Shenyang, People's Republic of China.
authors.forename: Zhuogang
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Peking University Institute of Hematology, Peking University People's Hospital, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 Xizhimen South Street, Beijing, People's Republic of China.
authors.forename: Jin
authors.initials: J
authors.lastname: Lu
authors.affiliation: Nanjing Drum Tower Hospital, Nanjing, People's Republic of China.
authors.forename: Jian
authors.initials: J
authors.lastname: Ouyang
authors.affiliation: Henan Tumour Hospital affiliated to Zhengzhou University, Zhengzhou, People's Republic of China.
authors.forename: Yongping
authors.initials: Y
authors.lastname: Song
authors.affiliation: Peking Union Medical College Hospital, Beijing, People's Republic of China.
authors.forename: Daobin
authors.initials: D
authors.lastname: Zhou
authors.affiliation: The First Hospital of Peking University, Beijing, People's Republic of China.
authors.forename: Hanyun
authors.initials: H
authors.lastname: Ren
authors.affiliation: Harbin Institute of Hematology and Oncology, Harbin, People's Republic of China.
authors.forename: Jun
authors.initials: J
authors.lastname: Ma
authors.affiliation: The First People's Hospital of Shanghai, Shanghai, People's Republic of China.
authors.forename: Chun
authors.initials: C
authors.lastname: Wang
authors.affiliation: Chinese PLA General Hospital (301 Hospital), Beijing, People's Republic of China.
authors.forename: Li
authors.initials: L
authors.lastname: Yu
authors.affiliation: The First Hospital of Harbin Medical University, Harbin, People's Republic of China.
authors.forename: Jin
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Changhai Hospital of the Second Military Medical University, Shanghai, People's Republic of China.
authors.forename: Jianmin
authors.initials: J
authors.lastname: Wang
authors.affiliation: The General Hospital of Guangzhou Military Command of PLA, Guangzhou, People's Republic of China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Xiao
authors.affiliation: Peking University Institute of Hematology, Peking University People's Hospital, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, No. 11 Xizhimen South Street, Beijing, People's Republic of China. huangxiaojun@bjmu.edu.cn.
authors.forename: Xiaojun
authors.initials: X
authors.lastname: Huang
authors.affiliation: Department of Hematology, The First Affiliated Hospital, SunYat-sen University, No. 58, Zhongshan Er Road, Guangzhou, 510080, People's Republic of China. 13719209240@163.com.
authors.forename: Juan
authors.initials: J
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D002681:China / Q000453:epidemiology; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D000072742:Invasive Fungal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole
keywords: Invasive fungal disease; Multicentre; Multiple myeloma; Prospective study