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Published on: July 1, 2020
Primary antifungal prophylaxis: decrease of invasive fungal disease incidence and reduction of risk factors in
Yan Li1, Mingjuan Liu1,2, Bing Zhai1,3
1Department of Hematology and BMT Center, Chinese PLA General Hospital, Beijing, China.
Background:
Invasive fungal disease (IFD) is a major cause of morbidity and mortality in patients with haematological malignancies.
Aim:
To evaluate the efficacy and rationality of primary antifungal prophylaxis (PAP) in a 5-year real-life setting and choose an appropriate PAP strategy.
Methods:
Clinical data of patients were retrospectively reviewed and IFD was diagnosed using the revised diagnostic criteria. The efficacy of PAP and the risk factors for IFD, especially the rationality of PAP, were evaluated.
Results:
Of the 1340 patients enrolled, 749 patients received PAP (55.9%), and IFD occurred in 157 patients: 51 (6.8%) in the PAP group and 106 (17.9%) in the non-PAP group (P = 0.000). The IFD-related mortality was 10.1 and 29.7% in the PAP group and non-PAP group (P = 0.000) respectively. PAP was an independent protective factor for IFD (odds ratio = 0.183, 95% confidence interval: 0.122-0.274, P = 0.000) and could reduce the effect of risk factors, such as allogeneic haemopoietic stem cell transplantation, prolonged neutropenia and corticosteroid. The IFD incidence was not significantly different among different PAP regimens and PAP start time subgroups, and it was lowest (4.2%) when PAP started after a short period of neutropenia (1-10 days).
Conclusion:
PAP is necessary and efficient to prevent IFD in haematological patients, and the real-life PAP strategy is reasonable. Different drugs can be chosen, and it is better to start PAP as soon as neutropenia begins.
Insights
Primary antifungal prophylaxis (PAP) is essential for preventing invasive fungal disease (IFD) in patients with blood cancers. Starting PAP early during neutropenia significantly reduces IFD incidence and mortality.
Area of Science:
- Hematology
- Infectious Diseases
- Pharmacology
Background:
- Invasive fungal disease (IFD) poses a significant threat, contributing to high morbidity and mortality rates in patients undergoing treatment for hematological malignancies.
- Effective strategies are crucial to mitigate the impact of IFD in this vulnerable patient population.
Purpose of the Study:
- To assess the real-world efficacy and appropriateness of primary antifungal prophylaxis (PAP) over a five-year period.
- To identify an optimal PAP strategy for patients with hematological malignancies.
Main Methods:
- Retrospective analysis of clinical data from 1340 patients diagnosed with IFD using revised criteria.
- Evaluation of PAP efficacy, IFD risk factors, and the rationality of PAP strategies employed.
Main Results:
- Patients receiving PAP (n=749) had a significantly lower IFD incidence (6.8%) compared to those not receiving PAP (17.9%).
- PAP was an independent protective factor against IFD (OR=0.183) and reduced the impact of risk factors like stem cell transplantation and corticosteroid use.
- IFD-related mortality was substantially lower in the PAP group (10.1%) versus the non-PAP group (29.7%).
- Optimal outcomes were observed when PAP commenced within 1-10 days of neutropenia onset, with an incidence of 4.2%.
Conclusions:
- Primary antifungal prophylaxis (PAP) is a necessary and effective intervention for preventing IFD in hematological patients.
- Current real-world PAP strategies are deemed reasonable, with flexibility in drug selection.
- Initiating PAP promptly upon the onset of neutropenia is recommended for maximum benefit.
