Secondary antifungal prophylaxis in hematological malignancy patients with previous invasive fungal disease: a retrospective analysis.

Mingjuan Liu,Honghua Li,Chunji Gao,Yan Li,Yongqing Zhang,Qingyi Zhang,Yu Zhao,Quanshun Wang,Li Yu,Wenrong Huang,Lijun Wang,Bing Zhai,Xiaoli Zhao,Vassiliki A Boussiotis

doi:10.1371/journal.pone.0115461

Abstract

BackgroundInvasive fungal disease (IFD) causes morbidity and mortality in patients with hematological malignancy. Recurrence of IFD after chemotherapy or hematopoietic stem cell transplantation (HSCT) is associated with poor prognosis. The present study aimed to investigate the efficacy of different strategies of secondary antifungal prophylaxis (SAP) for IFD and choose an appropriate SAP regimen.MethodsClinical data of patients with previous IFD who underwent chemotherapy or HSCT between Jan 2008 and Jun 2013 were retrospectively reviewed and followed up to 180 days post-chemotherapy or HSCT. The clinical characteristics and diagnosis were analyzed according to the diagnostic criteria for IFD. The efficacy of different strategies for SAP and risk factors influencing the failure of SAP were evaluated.ResultsOf the 164 patients enrolled, 121 patients received SAP regimen (73.78%), and IFD recurred in 40 patients: 16.5% (20/121) in SAP group and 46.5% (20/43) in non-SAP group. In SAP group, 58 received SAP agents which were proven effective for their previous IFD, while other 63 patients received other broad-spectrum antifungal agents. There was no significant difference in the recurrence rates between these two subgroups (13.8% (8/58) vs 19.0% (12/63), P = 0.437). The IFD recurrence rates were statistically significant between patients with allogeneic HSCT and chemotherapy or autologous HSCT (25% vs 8.2%, P = 0.013). Multivariate analysis indicated that allogeneic HSCT was the independent risk factor of IFD recurrence after SAP.ConclusionsSecondary antifungal prophylaxis is necessary to prevent IFD recurrence in patients with hematological malignancy, especially for patients in the setting of allogeneic HSCT.

Highlights

Invasive fungal disease (IFD) is associated with significant morbidity and mortality in patients with hematological malignancy [1, 2]
The IFD recurrence rates were statistically significant between patients with allogeneic hematopoietic stem cell transplantation (HSCT) and chemotherapy or autologous HSCT (25% vs 8.2%, P50.013)
Among the 77 patients who underwent allogeneic HSCT, acute GVHD occurred in 25 patients, chronic GVHD occurred in 29 patients, and cytomegalovirus (CMV) DNAemia [16] occurred in 42 patients

Summary

Introduction

Invasive fungal disease (IFD) is associated with significant morbidity and mortality in patients with hematological malignancy [1, 2]. Advancements in early diagnosis of IFD and introduction of new and more effective agents have improved the efficacy of primary antifungal treatment. It allows an increasing number of patients with hematological malignancy to undergo further chemotherapy and/or HSCT. The IFD recurrence rate after intensive chemotherapy is 16% [5] and 30–50% after HSCT [6] even with appropriate treatment. Recurrence of IFD after chemotherapy or hematopoietic stem cell transplantation (HSCT) is associated with poor prognosis. The IFD recurrence rates were statistically significant between patients with allogeneic HSCT and chemotherapy or autologous HSCT (25% vs 8.2%, P50.013)

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Discussion

Conclusion