伏立唑康似乎可预防白血病病人真菌感染复发
发布于 2004-04-09 · 浏览 1026 · IP 湖北湖北
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据Docguide.com2004年4月8日讯
研究人员指出，白血病病人在危险期使用伏立唑康（Voriconazole），似乎可预防真菌感染复发。
三唑类抗真菌药伏立唑康可有效对付曲霉菌属、念珠菌属和干细胞移植病人中一些罕见的真菌感染（如镰刀菌属或足分支霉菌属）。此药可口服或静注，研究表明它作为主要治疗有效且耐受性好。然而，对以前感染过真菌需要化疗的白血病人，它可能也可用作二级预防。为确定这一点，法国Henri Mondor医院血液科的科多尼尔（Catherine Cordonnier）和同事研究了11例用此药（400 mg/天，口服或静注，44-245天，平均137±57天）的白血病人。
所有病人每天均检查副作用，并常规生化学检查（包括血细胞计数、生化学、肝检，住院期间每周至少查两次，非住院期间每周一次）。10人以前感染过曲霉菌属，1人感染过念珠菌属，9人计划行干细胞移植，2人因急性白血病需巩固治疗。
作者报告，没一人真菌感染复发，除1人外其余均继续原定的化疗或移植，没人死于化疗引起的中性粒细胞减少症，没有重度副作用。免疫治疗期间给予环孢菌素没遇到困难，1人因为肝检结果异常停止治疗（后来的活检证实与移植物对宿主疾病有关），1人出现暂时的视觉障碍，但能继续治疗。
“尽管我们的研究规模较小，其结论仍表明伏立唑康用作白血病人危险时期特别是移植期的二级预防可让病人按既定安排完成治疗”，作者总结，“但还需要前瞻试验来证实这些结论”。详见《骨髓移植》杂志（Bone Marrow Transplant 2004 Mar 22）。
Secondary antifungal prophylaxis with voriconazole to adhere to scheduled treatment in leukemic patients and stem cell transplant recipients.
Cordonnier C, Maury S, Pautas C, Bastie JN, Chehata S, Castaigne S, Kuentz M, Bretagne S, Ribaud P.
1Hematology Department, Henri Mondor Hospital, Creteil, France.
Summary:Although the efficacy and safety of voriconazole to treat invasive fungal infections have been demonstrated in prospective trials, its use for secondary prophylaxis to prevent reactivation of these infections remains unknown. Delaying the scheduled treatment of leukemia until complete resolution of fungal infection may have major implications for prognosis. We report 11 leukemic patients with previous aspergillus (n=10) and candida (n=1) infection who received voriconazole 400 mg/day intravenously or orally for between 44 and 245 days. Nine patients were scheduled for allogeneic stem cell transplant, and two for consolidation therapy for acute leukemia. None of the patients had a relapse of fungal infection, and scheduled treatment was delayed only once. Voriconazole was well tolerated, except in one patient who had abnormal liver tests secondary to hepatic graft-versus-host disease, and one who had visual disturbances. This small but homogeneous series indicates that voriconazole may be useful to prevent fungal relapse during at-risk periods in leukemic patients. Prospective trials are warranted to confirm these encouraging results.
Bone Marrow Transplantation advance online publication, 22 March 2004
研究人员指出，白血病病人在危险期使用伏立唑康（Voriconazole），似乎可预防真菌感染复发。
三唑类抗真菌药伏立唑康可有效对付曲霉菌属、念珠菌属和干细胞移植病人中一些罕见的真菌感染（如镰刀菌属或足分支霉菌属）。此药可口服或静注，研究表明它作为主要治疗有效且耐受性好。然而，对以前感染过真菌需要化疗的白血病人，它可能也可用作二级预防。为确定这一点，法国Henri Mondor医院血液科的科多尼尔（Catherine Cordonnier）和同事研究了11例用此药（400 mg/天，口服或静注，44-245天，平均137±57天）的白血病人。
所有病人每天均检查副作用，并常规生化学检查（包括血细胞计数、生化学、肝检，住院期间每周至少查两次，非住院期间每周一次）。10人以前感染过曲霉菌属，1人感染过念珠菌属，9人计划行干细胞移植，2人因急性白血病需巩固治疗。
作者报告，没一人真菌感染复发，除1人外其余均继续原定的化疗或移植，没人死于化疗引起的中性粒细胞减少症，没有重度副作用。免疫治疗期间给予环孢菌素没遇到困难，1人因为肝检结果异常停止治疗（后来的活检证实与移植物对宿主疾病有关），1人出现暂时的视觉障碍，但能继续治疗。
“尽管我们的研究规模较小，其结论仍表明伏立唑康用作白血病人危险时期特别是移植期的二级预防可让病人按既定安排完成治疗”，作者总结，“但还需要前瞻试验来证实这些结论”。详见《骨髓移植》杂志（Bone Marrow Transplant 2004 Mar 22）。
Secondary antifungal prophylaxis with voriconazole to adhere to scheduled treatment in leukemic patients and stem cell transplant recipients.
Cordonnier C, Maury S, Pautas C, Bastie JN, Chehata S, Castaigne S, Kuentz M, Bretagne S, Ribaud P.
1Hematology Department, Henri Mondor Hospital, Creteil, France.
Summary:Although the efficacy and safety of voriconazole to treat invasive fungal infections have been demonstrated in prospective trials, its use for secondary prophylaxis to prevent reactivation of these infections remains unknown. Delaying the scheduled treatment of leukemia until complete resolution of fungal infection may have major implications for prognosis. We report 11 leukemic patients with previous aspergillus (n=10) and candida (n=1) infection who received voriconazole 400 mg/day intravenously or orally for between 44 and 245 days. Nine patients were scheduled for allogeneic stem cell transplant, and two for consolidation therapy for acute leukemia. None of the patients had a relapse of fungal infection, and scheduled treatment was delayed only once. Voriconazole was well tolerated, except in one patient who had abnormal liver tests secondary to hepatic graft-versus-host disease, and one who had visual disturbances. This small but homogeneous series indicates that voriconazole may be useful to prevent fungal relapse during at-risk periods in leukemic patients. Prospective trials are warranted to confirm these encouraging results.
Bone Marrow Transplantation advance online publication, 22 March 2004
最后编辑于 2004-04-09 · 浏览 1026
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