PDF(Pubmed)
Abstract：
UNASSIGNED: Continuing antifungal prophylaxis (AFPx) to prevent invasive mold infections (IMIs) in recipients of allogeneic hematopoietic cell transplantation (alloHCT) after primary hospital discharge from alloHCT admission varies among transplant centers despite recommendations to continue prophylaxis through day +75. Characteristics driving AFPx prescribing at hospital discharge and outcomes are unknown.
UNASSIGNED: In this retrospective analysis, we reviewed patients continuing AFPx vs no AFPx at hospital discharge. We included patients with a hospital stay ≥7 days and ≤40 days. We excluded patients with a history of IMI prior to alloHCT, new IMI during admission, or death prior to discharge. Our primary objective was incidence of probable or proven IMI per the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Our secondary objectives were nonrelapse mortality at day +100, overall survival at day +100, and characteristics driving AFPx discontinuation at hospital discharge.
UNASSIGNED: Of the 430 patients identified, 387 met inclusion criteria. At discharge, 56% (217/387) continued AFPx, and 44% (170/387) had no AFPx. At day +100, 3 probable IMI cases occurred in the group with continued AFPx vs 1 probable IMI case in the no-AFPx group (no proven IMI). Univariate analysis showed no difference in cumulative incidence of probable IMI (P = .440), nonrelapse mortality (P = .072), and overall survival (P = .855) between groups. Multivariable logistic regression demonstrated that patients were less likely to continue AFPx if they had a diagnosis other than acute myeloid leukemia, a length of stay ≤30 days, acute graft-vs-host disease grade 0 or 1, and corticosteroid use ≤5 days.
UNASSIGNED: There was no difference in probable IMI at day +100 after alloHCT based on continuing vs discontinuing AFPx at hospital discharge after alloHCT admission supporting a risk-adapted prophylaxis approach.
UNASSIGNED: In this retrospective analysis, we reviewed patients continuing AFPx vs no AFPx at hospital discharge. We included patients with a hospital stay ≥7 days and ≤40 days. We excluded patients with a history of IMI prior to alloHCT, new IMI during admission, or death prior to discharge. Our primary objective was incidence of probable or proven IMI per the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Our secondary objectives were nonrelapse mortality at day +100, overall survival at day +100, and characteristics driving AFPx discontinuation at hospital discharge.
UNASSIGNED: Of the 430 patients identified, 387 met inclusion criteria. At discharge, 56% (217/387) continued AFPx, and 44% (170/387) had no AFPx. At day +100, 3 probable IMI cases occurred in the group with continued AFPx vs 1 probable IMI case in the no-AFPx group (no proven IMI). Univariate analysis showed no difference in cumulative incidence of probable IMI (P = .440), nonrelapse mortality (P = .072), and overall survival (P = .855) between groups. Multivariable logistic regression demonstrated that patients were less likely to continue AFPx if they had a diagnosis other than acute myeloid leukemia, a length of stay ≤30 days, acute graft-vs-host disease grade 0 or 1, and corticosteroid use ≤5 days.
UNASSIGNED: There was no difference in probable IMI at day +100 after alloHCT based on continuing vs discontinuing AFPx at hospital discharge after alloHCT admission supporting a risk-adapted prophylaxis approach.
摘要：
■继续抗真菌预防（AFPx）以防止同种异体造血细胞移植（aloHCT）的受者在从alloHCT入院后出院后的侵袭性霉菌感染（IMIs），尽管建议在75天之前继续进行预防，但在移植中心中有所不同。出院时驱动AFPx处方的特征和结果未知。
■在此回顾性分析中，我们回顾了出院时继续AFPx和无AFPx的患者.我们纳入了住院时间≥7天和≤40天的患者。我们排除了在alloHCT之前有IMI病史的患者，入院期间的新IMI，或出院前死亡。我们的主要目标是根据欧洲癌症研究与治疗组织和真菌病研究小组教育与研究联盟的可能或已证实的IMI的发生率。我们的次要目标是第+100天的非复发死亡率，第+100天的总生存期以及出院时导致AFPx停药的特征。
■在确定的430名患者中，387符合纳入标准。出院时,56%(217/387)继续AFPx，44%(170/387)无AFPx。在第100天，该组发生了3例可能的IMI病例，其中AFPx持续，而无AFPx组（无已证实的IMI）发生了1例可能的IMI病例。单变量分析显示可能的IMI的累积发生率没有差异（P=.440），非复发死亡率（P=.072），组间总生存率（P=.855）。多变量逻辑回归表明，如果患者诊断为急性髓细胞性白血病以外的其他患者，则他们不太可能继续AFPx。停留时间≤30天，急性移植物抗宿主病0级或1级，皮质类固醇使用≤5天。
■根据支持适应风险的预防方法的alloHCT入院后出院时继续与停止AFPx，alloHCT后第100天的可能IMI没有差异。
■在此回顾性分析中，我们回顾了出院时继续AFPx和无AFPx的患者.我们纳入了住院时间≥7天和≤40天的患者。我们排除了在alloHCT之前有IMI病史的患者，入院期间的新IMI，或出院前死亡。我们的主要目标是根据欧洲癌症研究与治疗组织和真菌病研究小组教育与研究联盟的可能或已证实的IMI的发生率。我们的次要目标是第+100天的非复发死亡率，第+100天的总生存期以及出院时导致AFPx停药的特征。
■在确定的430名患者中，387符合纳入标准。出院时,56%(217/387)继续AFPx，44%(170/387)无AFPx。在第100天，该组发生了3例可能的IMI病例，其中AFPx持续，而无AFPx组（无已证实的IMI）发生了1例可能的IMI病例。单变量分析显示可能的IMI的累积发生率没有差异（P=.440），非复发死亡率（P=.072），组间总生存率（P=.855）。多变量逻辑回归表明，如果患者诊断为急性髓细胞性白血病以外的其他患者，则他们不太可能继续AFPx。停留时间≤30天，急性移植物抗宿主病0级或1级，皮质类固醇使用≤5天。
■根据支持适应风险的预防方法的alloHCT入院后出院时继续与停止AFPx，alloHCT后第100天的可能IMI没有差异。
