Empirical versus diagnostic-driven antifungal therapy for hematological malignancies patients with inva-sive fungal disease / 国际肿瘤学杂志

ABSTRACT

Objective To compare the clinical efficacy of empirical therapy and diagnostic-driven the-rapy in the treatment of the hematological malignancies patients complicated with invasive fungal disease (IFD). Methods The clinical data of patients with hematological malignancies undergoing antifungal treat-ment in the Department of Hematology and Lymphoma of Cancer Hospital & Shenzhen Hospital,Chinese Aca-demy of Medical Sciences and Peking Union Medical College from August 2017 to August 2018 were analyzed retrospectively. A total of 68 patients met the inclusion criteria,of which,28 received the empirical therapy and 40 received the diagnostic-driven therapy. Then the differences of the incidence of IFD,IFD-related mor-tality,days of hospitalization and antifungal treatment between the two groups were compared. Results The incidence of IFD in the diagnostic-driven therapy group was higher than that in the empirical therapy group [27. 5％ (11 / 40)vs. 7. 1％ (2 / 28),χ2 = 4. 414,P = 0. 036]. While the rates of IFD-related mortality were 7. 5％ (3 / 40)and 3. 6％ (1 / 28)respectively,with no statistically significant difference (χ2 = 0. 459,P =0. 498). The number of antifungal treatment days in the diagnostic-driven therapy group was greater than that in the empirical therapy group [(15. 9 ± 3. 3)d vs. (13. 1 ± 2. 5)d,t = - 3. 654,P = 0. 001]. While the num-bers of hospitalization days were similar in the two groups [(20. 1 ± 2. 1)d vs. (19. 4 ± 2. 3)d],with no sta-tistically significant difference (t = - 1. 273,P = 0. 208). Conclusion Both diagnostic-driven therapy and empirical therapy are helpful to early antifungal treatment,and they should be performed properly combined with the actual clinical conditions.