The clinical features and risk factors for invasive fungal infection in multiple myeloma / 中华内科杂志

ABSTRACT

Objective To study the clinical features and risk factors of invasive fungal infection (IFI) in multiple myeloma ( MM) . Methods Three hundred and fifty-seven cases of MM were retrospectively analyzed for IFI, clinical features, complicating diseases, treatment of fungus and side effect of anti-fungal drugs. Results Forty-four cases ( 12. 3% ) of IFI were diagnosed. Three of them were diagnosed definitely, 8 clinically and 33 probably. Ten cases incurred IFI in (he induction therapy, 4 in platform, 27 in progress and 3 in the treatment with autologous stem cell transplantation. The lung was the commonest site of infection ( 50. 0% ) . The total effective rates of amphotericin B liposome, voriconazole, itraconazole, caspofungin and fluconazol were 83. 3% , 75. 0% , 78. 9% , 75. 0% and 57. 1% respectively (P= 0.493). In a multivariate analysis, independent factors significantly associated with IFI were diabetes (P=0.035, OR 2. 527, 95%CI 1.005-6.052), dialysis (P=0. 022,OR 2. 768, 95%CI 1. 161-6. 600), persistent agranulocytosis (P = 0.019, OR 3.215, 95% CI 1.200-7.407), broad-spectrum antibiotic therapy (P = 0.009,OR 3. 350,95% CI 1.353-8.295) and fludarabine treatment( P = 0. 001,0R 4. 669, 95% CI 1.813-12.023). Conclusions Patients with MM are in high risk of IFI. The lung is the commonest site of infection. The therapeutic effect was similar with itraconazole, voriconazole, caspofungin and amphotericin B liposome in MM patients with complicating IFI. The risk factors for IFI in MM were diabetes, dialysis, persistent agranulocytosis and the use of broad-spectrum antibiotics and fludarabine.