高リスク・発熱性好中球減少症の固形腫瘍患者に対する先制的抗真菌療法 vs. 経験的抗真菌療法の比較：LMIC設定での検討

Preemptive antifungal therapy in neutropenic fever offers a rational alternative to the empiric strategy, potentially reducing drug toxicity, resistance, and treatment-related costs. However, its implementation in the Middle East and North Africa (MENA) region remains insufficiently addressed.

We prospectively observed episodes of neutropenia in pediatric patients with solid tumors and prolonged neutropenia. This non-inferiority cohort study evaluated two primary endpoints: the cumulative incidence of invasive fungal infection (IFI), IFI-attributable mortality. Outcomes from the prospective cohort managed with a preemptive strategy were compared with retrospective data from a historical cohort treated with the previously used empiric approach.

A total of 422 preemptive episodes were prospectively recorded, and data from 338 historical empiric episodes were retrospectively reviewed. The incidence of IFI was comparable between the two groups (4.5% in the preemptive group vs. 5.6% in the empiric group; p = 0.5). However, antifungal use was significantly lower in the preemptive group (5.0% vs. 58.0%; p < 0.001). Overall survival was higher in the preemptive group (98.9% vs. 94.6%). No IFI-attributable mortality was recorded in either group.

The combined EIA/HRCT-based preemptive strategy is feasible and associated with reduced antifungal use without compromising patient outcomes in pediatric patients with solid tumors and prolonged neutropenia.