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

PLoS One. 2014 Dec 22;9(12):e115461. doi: 10.1371/journal.pone.0115461. eCollection 2014.

Abstract

Background: Invasive 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.

Methods: Clinical 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.

Results: Of 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.

Conclusions: Secondary antifungal prophylaxis is necessary to prevent IFD recurrence in patients with hematological malignancy, especially for patients in the setting of allogeneic HSCT.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antifungal Agents / therapeutic use*
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Child
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Hematologic Neoplasms / complications*
  • Hematologic Neoplasms / mortality
  • Hematologic Neoplasms / therapy
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Humans
  • Male
  • Middle Aged
  • Mycoses / drug therapy*
  • Mycoses / etiology
  • Mycoses / mortality
  • Prognosis
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Secondary Prevention
  • Survival Rate
  • Transplantation, Homologous
  • Young Adult

Substances

  • Antifungal Agents

Grants and funding

This work was supported by grants from the National Basic Research Program of China (2005CB522400), National Natural Science Foundation of China (90919044, 30971297, 81170518, 81270611), Capital Medical Development Scientific Research Fund (SF2001-5001-07), National Public Health Grant Research Foundation (201202017), the capital of the public health project (Z111107067311070) and Technology Innovation Nursery Foundation (13KMM01). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.