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

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

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

Author: Ling WANG ¹ ; Ying WANG ¹ ; Jiong HU ² ; Yuqian SUN ³ ; He HUANG ⁴ ; Jing CHEN ⁵ ; Jianyong LI ⁶ ; Jun MA ⁷ ; Juan LI ⁸ ; Yingmin LIANG ⁹ ; Jianmin WANG ¹⁰ ; Yan LI ¹¹ ; Kang YU ¹² ; Jianda HU ¹³ ; Jie JIN ⁴ ; Chun WANG ¹⁴ ; Depei WU ¹⁵ ; Yang XIAO ¹⁶ ; Xiaojun HUANG ¹⁷
Author Information

1. Blood & Marrow Transplantation Center, Department of Hematology, Collaborative Innovation Center of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
2. Blood & Marrow Transplantation Center, Department of Hematology, Collaborative Innovation Center of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China. hj10709@rjh.com.cn.
3. Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University, People's Hospital, Beijing, 100044, China.
4. Department of Hematology, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, 310003, China.
5. Department of Hematology-Oncology, Shanghai Children's Medical Center, Shanghai, 200127, China.
6. Department of Hematology, Jiangsu Province Hospital, Nanjing, 210029, China.
7. Harbin Hematologic Tumor Institution, Harbin, 150010, China.
8. Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.
9. Department of Hematology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710032, China.
10. Department of Hematology, Changhai Hospital of the Second Military Medical University, Shanghai, 200082, China.
11. Department of Hematology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China.
12. Department of Hematology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, 325000, China.
13. Department of Hematology, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
14. Department of Hematology, The First People's Hospital of Shanghai, Shanghai, 200080, China.
15. Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
16. Department of Hematology, The General Hospital of Guangzhou Military Command of PLA, Guangzhou, 510010, China.
17. Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University, People's Hospital, Beijing, 100044, China. huangxiaojun@bjmu.edu.cn.
Publication Type:Journal Article
Keywords: chemotherapy; hematological malignancies; invasive fungal diseases; prophylaxis; risk score
From: Frontiers of Medicine 2019;13(3):365-377
CountryChina
Language:English
Abstract: 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.