Abstract：
BACKGROUND: Although neurotoxicity is a major adverse event associated with busulfan, little information is available regarding the association between drug interactions and neurological symptoms during busulfan-based regimens. This study evaluated the association between prophylactic echinocandins and neurological complications in patients receiving busulfan-containing conditioning regimens for stem cell transplantation.
METHODS: We retrospectively included consecutive patients who administered intravenous busulfan as a conditioning regimen at our facility between 2007 and 2022. Prophylactic echinocandin use was defined as the use of an echinocandin antifungal drug to prevent invasive fungal disease in SCT recipients. The primary outcome was the incidence of neurological complications within 7 days of busulfan initiation and was compared between the echinocandin group (patients received prophylactic echinocandin) and nonechinocandin group (patients received prophylactic antifungal drugs other than echinocandin and those without antifungal prophylaxis).
RESULTS: Among the 59 patients included in this study, the incidence of neurological complications in the echinocandin (n = 26) and nonechinocandin groups (n = 33) was 30.8% and 63.6%, respectively. We observed a negative association between prophylactic echinocandin use and the development of neurological complications after adjusting for the propensity score for receiving prophylactic echinocandins (adjusted odds ratio 0.294, 95% confidence interval 0.090 to 0.959). We observed a lower incidence of neurological complications in the echinocandin group than in the nonechinocandin group.
CONCLUSIONS: Our results suggested that the choice of antifungal prophylaxis is associated with busulfan neurotoxicity.
METHODS: We retrospectively included consecutive patients who administered intravenous busulfan as a conditioning regimen at our facility between 2007 and 2022. Prophylactic echinocandin use was defined as the use of an echinocandin antifungal drug to prevent invasive fungal disease in SCT recipients. The primary outcome was the incidence of neurological complications within 7 days of busulfan initiation and was compared between the echinocandin group (patients received prophylactic echinocandin) and nonechinocandin group (patients received prophylactic antifungal drugs other than echinocandin and those without antifungal prophylaxis).
RESULTS: Among the 59 patients included in this study, the incidence of neurological complications in the echinocandin (n = 26) and nonechinocandin groups (n = 33) was 30.8% and 63.6%, respectively. We observed a negative association between prophylactic echinocandin use and the development of neurological complications after adjusting for the propensity score for receiving prophylactic echinocandins (adjusted odds ratio 0.294, 95% confidence interval 0.090 to 0.959). We observed a lower incidence of neurological complications in the echinocandin group than in the nonechinocandin group.
CONCLUSIONS: Our results suggested that the choice of antifungal prophylaxis is associated with busulfan neurotoxicity.
摘要：
背景：尽管神经毒性是与白消安相关的主要不良事件，关于以白消安为基础的治疗方案中药物相互作用与神经系统症状之间的关联的信息很少.这项研究评估了接受含白消安的预处理方案进行干细胞移植的患者的预防性棘白菌素类与神经系统并发症之间的关系。
方法：我们回顾性地纳入了2007年至2022年间在我们的机构给予静脉注射白消安作为预处理方案的连续患者。预防性使用棘白菌素被定义为使用棘白菌素抗真菌药物来预防SCT接受者的侵袭性真菌病。主要结果是白消安开始后7天内神经系统并发症的发生率，并在棘白菌素组（患者接受预防性棘白菌素）和非棘白菌素组（患者接受除棘白菌素以外的预防性抗真菌药物和无抗真菌预防）之间进行了比较。
结果：本研究纳入的59例患者中，棘白菌素（n=26）和非棘白菌素组（n=33）的神经系统并发症发生率分别为30.8%和63.6%，分别。在调整接受预防性棘白菌素的倾向评分后，我们观察到预防性棘白菌素的使用与神经系统并发症的发展之间呈负相关（调整后的比值比0.294，95％置信区间0.090至0.959）。我们观察到棘白菌素组的神经系统并发症发生率低于非棘白菌素组。
结论：我们的结果表明，选择抗真菌预防与白消安神经毒性有关。
方法：我们回顾性地纳入了2007年至2022年间在我们的机构给予静脉注射白消安作为预处理方案的连续患者。预防性使用棘白菌素被定义为使用棘白菌素抗真菌药物来预防SCT接受者的侵袭性真菌病。主要结果是白消安开始后7天内神经系统并发症的发生率，并在棘白菌素组（患者接受预防性棘白菌素）和非棘白菌素组（患者接受除棘白菌素以外的预防性抗真菌药物和无抗真菌预防）之间进行了比较。
结果：本研究纳入的59例患者中，棘白菌素（n=26）和非棘白菌素组（n=33）的神经系统并发症发生率分别为30.8%和63.6%，分别。在调整接受预防性棘白菌素的倾向评分后，我们观察到预防性棘白菌素的使用与神经系统并发症的发展之间呈负相关（调整后的比值比0.294，95％置信区间0.090至0.959）。我们观察到棘白菌素组的神经系统并发症发生率低于非棘白菌素组。
结论：我们的结果表明，选择抗真菌预防与白消安神经毒性有关。
