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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

  • 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
Research Article
  • 7 Downloads

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.

Keywords

invasive fungal diseases hematological malignancies chemotherapy risk score prophylaxis 

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Copyright information

© Higher Education Press and Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Ling Wang
    • 1
  • Ying Wang
    • 1
  • Jiong Hu
    • 1
  • Yuqian Sun
    • 2
  • He Huang
    • 3
  • Jing Chen
    • 4
  • Jianyong Li
    • 5
  • Jun Ma
    • 6
  • Juan Li
    • 7
  • Yingmin Liang
    • 8
  • Jianmin Wang
    • 9
  • Yan Li
    • 10
  • Kang Yu
    • 11
  • Jianda Hu
    • 12
  • Jie Jin
    • 3
  • Chun Wang
    • 13
  • Depei Wu
    • 14
  • Yang Xiao
    • 15
  • Xiaojun Huang
    • 2
  1. 1.Blood & Marrow Transplantation Center, Department of Hematology, Collaborative Innovation Center of HematologyRuijin Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
  2. 2.Beijing Key Laboratory of Hematopoietic Stem Cell TransplantationPeking University Institute of Hematology, Peking University, People’s HospitalBeijingChina
  3. 3.Department of HematologyThe First Affiliated Hospital of Medical School of Zhejiang UniversityHangzhouChina
  4. 4.Department of Hematology-OncologyShanghai Children’s Medical CenterShanghaiChina
  5. 5.Department of HematologyJiangsu Province HospitalNanjingChina
  6. 6.Harbin Hematologic Tumor InstitutionHarbinChina
  7. 7.Department of HematologyThe First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina
  8. 8.Department of Hematology, Tangdu HospitalFourth Military Medical UniversityXi’anChina
  9. 9.Department of HematologyChanghai Hospital of the Second Military Medical UniversityShanghaiChina
  10. 10.Department of HematologyThe First Affiliated Hospital of China Medical UniversityShenyangChina
  11. 11.Department of HematologyThe First Affiliated Hospital of Wenzhou Medical CollegeWenzhouChina
  12. 12.Department of HematologyFujian Medical University Union HospitalFuzhouChina
  13. 13.Department of HematologyThe First People’s Hospital of ShanghaiShanghaiChina
  14. 14.Department of HematologyThe First Affiliated Hospital of Soochow UniversitySuzhouChina
  15. 15.Department of HematologyThe General Hospital of Guangzhou Military Command of PLAGuangzhouChina

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