Clinical analysis of metagenome next-generation sequencing for diagnosing invasive fungal disease in patients with early stage of hematopoietic stem cell transplantation
10.16016/j.2097-0927.202310087
- VernacularTitle:应用宏基因组二代测序诊断异基因造血干细胞移植后早期侵袭性真菌病患者的临床分析
- Author:
Yuhan JI
1
,
2
;
Mingyue PAN
;
Xiaoyu LAI
;
Lizhen LIU
;
Jimin SHI
;
Yanmin ZHAO
;
Jian YU
;
Luxin YANG
;
Yi LUO
Author Information
1. 310000 杭州,浙江大学医学院附属第一医院骨髓移植中心
2. 473000 南阳,南阳市第二人民医院血液内科
- Keywords:
metagenomic next-generation sequencing;
allogeneic hematopoietic stem cell transplantion;
invasive fungal disease
- From:
Journal of Army Medical University
2024;46(4):311-318
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the clinical outcomes of early invasive fungal disease(IFD)in patients after allogenetic hematopoietic stem cell transplantation(allo-HCST)with metagenomic next-generation sequencing(mNGS).Methods A retrospective analysis was conducted on patients undergoing allo-HCST in our Bone Marrow Transplantation Center between July 2021 and October 2022.These patients experienced one of the following conditions within 100 d after transplantation:① Patients with persistent fever and negative blood culture after empiric antimicrobial therapy for 72 h or longer;② Hyperpyrexia of unknown origin occurred again after effective anti-infection in the past;③ Symptoms in lower respiratory tract associated with lung lesions on CT scan,and empiric anti-infective therapy was ineffective.Peripheral blood or bronchoscopic alveolar lavage fluid were tested with mNGS,and overall survival(OS)and non-relapse mortality(NRM)were analyzed.Results There were 60 patients enrolled in this study.For the peripheral blood samples of 47 cases and bronchoalveolar lavage fluid samples of 13 cases,mNGS found that 19 cases were negative to pathogens,30 cases were non-fungal positive,and 11 case were fungal positive,including 3 cases of aspergillus,5 cases of mucor,2 cases of Candida tropicalis,and 1 case of Trichosporon asahii.Of the 11 patients with fungal positive,8 achieved complete remission after antifungal therapy according to the mNGS results.The 1-year OS and NRM of the 60 patients were 70.0％(95％CI:64.1％～75.9％)and 20.0％(95％CI:11.9％～32.5％),respectively,while those of the fungal infection patients were 54.5％(95％CI:49.5％～69.5％)and 36.4％(95％ CI:15.5％～70.3％),respectively.No significant differences were seen in 1-year OS(P=0.487)and 1-year NRM(P=0.358)among the negative,fungal infection and non-fungal infection patients,neither OS(P=0.238)and NRM(P=0.154)between the fungal infection and the non-fungal infection patients.Conclusion mNGS can rapidly diagnose the early IFD after allo-HSCT,which is helpful for timely and effective treatment and improves the prognosis of patients.
