Clinical risk score for invasive fungal diseases in patients with hematological malignancies undergoing chemotherapy:China Assessment of Antifungal Therapy in Hematological Diseases (CAESAR) study

作     者：Ling Wang Ying Wang Jiong Hu Yuqian Sun He Huang Jing Chen Jianyong Li Jun Ma Juan Li Yingmin Liang Jianmin Wang Yan Li Kang Yu Jianda Hu Jie Jin Chun Wang Depei Wu Yang Xiao Xiaojun Huang 

作者机构：Blood & Marrow Transplantation CenterDepartment of HematologyCollaborative Innovation Center of HematologyRuijin Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai 200025China Department of HematologyThe First Affiliated Hospital of China Medical UniversityShenyang 110001China Department of HematologyThe First Affiliated Hospital of Wenzhou Medical CollegeWenzhou 325000China Department of HematologyFujian Medical University Union HospitalFuzhou 350001China Department of HematologyThe First People's Hospital of ShanghaiShanghai 200080China Department of HematologyThe First Affiliated Hospital of Soochow UniversitySuzhou 215006China Department of HematologyThe General Hospital of Guangzhou Military Command of PLAGuangzhou 510010China Peking University Institute of HematologyPeking UniversityPeople's HospitalBeijing Key Laboratory of Hematopoietic Stem Cell TransplantationBeijing 100044China Department of HematologyThe First Affiliated Hospital of Medical School of Zhejiang UniversityHangzhou 310003China Department of Hematology-OncologyShanghai Children's Medical CenterShanghai 200127China Department of HematologyJiangsu Province HospitalNanjing 210029China Harbin Hematologic Tumor InstitutionHarbin 150010China Department of HematologyThe First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510080China Department of HematologyTangdu HospitalFourth Military Medical UniversityXi'an 710032China Department of HematologyChanghai Hospital of the Second Military Medical UniversityShanghai 200082China 

出 版 物：《Frontiers of Medicine》 (医学前沿（英文版）)

年 卷 期：2019年第13卷第3期

页      面：365-377页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

基　　金：supported by Merck Sharp & Dohme(China) support for the manuscript development was provided by Merck & Co.,Inc.(Whitehouse Station,NJ,USA) 

主　　题：invasive fungal diseases hematological malignancies chemotherapy risk score prophylaxis 

摘      要：Invasive fungal disease (IFD) is a major infectious complication in patients with hematological malignancies.In this study,we examined 4889 courses of chemotherapy in patients with hematological diseases to establish a training dataset (n=3500) by simple random sampling to develop a weighted risk score for proven or probable IFD through multivariate regression,which included the following variables: male patients,induction chemotherapy for newly diagnosed or relapsed disease,neutropenia,neutropenia longer than 10 days,hypoalbuminemia,central-venous catheter,and history of IFD.The patients were classified into three groups,which had low (0-10,~1.2%),intermediate (11-15,6.4%),and high risk ( 15,17.5%) of IFD.In the validation set (n=1389),the IFD incidences of the groups were ~1.4%,5.0%,and 21.4%.In addition,we demonstrated that antifungal prophylaxis offered no benefits in low-risk patients,whereas benefits were documented in intermediate (2.1% vs.6.6%,P=0.007) and high-risk patients (8.4% vs.23.3%,P=0.007).To make the risk score applicable for clinical settings,a pre-chemo risk score that deleted all unpredictable factors before chemotherapy was established,and it confirmed that anti-fungal prophylaxis was beneficial in patients with intermediate and high risk of IFD.In conclusion,an objective,weighted risk score for IFD was developed,and it may be useful in guiding antifungal prophylaxis.