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Antifungal Strategy in Patients with Invasive Fungal Disease Associated with Hematological Malignancies Based on Risk
Lijin Chen1,2, Luting Luo1, Yanxin Chen1
1Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China.
Abstract:
Patients with hematological malignancies (HM) often develop the invasive fungal disease (IFD), causing important morbidity/mortality. While treatment guidelines are available, risk stratification models for optimizing antifungal therapy strategies are few. Clinical records from 458 HM patients with IFD were retrospectively analyzed. Following Chinese treatment guidelines, patients received empirical (n = 239) or diagnostic-driven therapy (n = 219). The effectiveness rate was 87.9% for the empirical and 81.7% for the diagnostic-driven therapy groups (P ≥ 0.05). The incidence of adverse reactions was 18.4% and 16.9%, respectively (P ≥ 0.05). All risk factors of IFD in HM patients were estimated in the univariate analyses and multivariate analyses by the chi-square test and logistic regression model. Duration ≥14 days (OR = 18.340, P=0.011), relapsed/refractory disease (OR = 11.670, P=0.005), IFD history (OR = 5.270, P=0.021), and diabetes (OR = 3.120, P=0.035) were significantly associated with IFD in the multivariate analysis. Patients with more than 3 of these factors have a significant difference in effective rates between the empirical (85.7%) and diagnostic-driven (41.6%) therapy (P=0.008). Empirical and diagnostic-driven therapy effective rates were 80.6% and 70.9% in the patients with two risk factors (P > 0.05) and 85.1% and 85.4% in the patients with one risk factor (P > 0.05). Thus, there was no significant difference in effectiveness in patients with one or two risk factors. The abovementioned risk stratification can guide clinical antifungal therapy. The patients with 3 or more risk factors benefit from empirical therapy.
Insights
This study found that empirical antifungal therapy is more effective for hematological malignancy patients with invasive fungal disease and three or more risk factors. Risk stratification guides optimal antifungal strategies for these vulnerable patients.
Area of Science:
- Hematology
- Infectious Diseases
- Medical Mycology
Background:
- Hematological malignancies (HM) patients frequently develop invasive fungal disease (IFD), leading to significant morbidity and mortality.
- Existing treatment guidelines for IFD in HM patients exist, but risk stratification models for optimizing antifungal therapy are limited.
- There is a need for better strategies to tailor antifungal treatments based on individual patient risk.
Purpose of the Study:
- To evaluate the effectiveness of empirical versus diagnostic-driven antifungal therapy in patients with hematological malignancies and IFD.
- To identify and analyze risk factors associated with IFD in HM patients.
- To develop a risk stratification model to guide the selection of antifungal therapy strategies.
Main Methods:
- Retrospective analysis of clinical records from 458 HM patients diagnosed with IFD.
- Patients were divided into empirical therapy (n=239) and diagnostic-driven therapy (n=219) groups based on Chinese treatment guidelines.
- Univariate and multivariate analyses (chi-square test, logistic regression) were used to identify IFD risk factors.
Main Results:
- Overall effectiveness rates were comparable between empirical (87.9%) and diagnostic-driven (81.7%) therapy groups (P ≥ 0.05).
- Significant risk factors for IFD in HM patients included duration ≥14 days, relapsed/refractory disease, IFD history, and diabetes.
- Patients with ≥3 risk factors showed significantly higher effectiveness with empirical therapy (85.7%) compared to diagnostic-driven therapy (41.6%) (P=0.008).
Conclusions:
- Empirical antifungal therapy demonstrates superior effectiveness in HM patients with IFD and three or more identified risk factors.
- The identified risk factors (duration ≥14 days, relapsed/refractory disease, IFD history, diabetes) can be used for risk stratification.
- This risk stratification model can guide clinicians in optimizing antifungal therapy strategies for HM patients with IFD.
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