皮下注射粒细胞-巨噬细胞集落刺激因子预防多发性骨髓瘤患者侵袭性真菌病效果分析  

Efficacy analysis of subcutaneous injection of granulocyte-macrophage colony-stimulating factor for prevention of invasive fungal disease in patients with multiple myeloma

作　　者：田垚垚[1] 董秀帅[1] 任雨悦 李晓云[1] 戴海滨[1] 王京华[1] 赵薇薇 常玉莹[1] 陈曦[1] 王巍[1] Tian Yaoyao;Dong Xiushuai;Ren Yuyue;Li Xiaoyun;Dai Haibin;Wang Jinghua;Zhao Weiwei;Chang Yuying;Chen Xi;Wang Wei(Department of Hematology,the Second Affiliated Hospital of Harbin Medical University,Harbin 150081,China)

机构地区：[1]哈尔滨医科大学附属第二医院血液科,哈尔滨150081

出　　处：《白血病．淋巴瘤》2023年第5期284-288,共5页Journal of Leukemia & Lymphoma

基　　金：中国博士后科学基金(2015M580270);黑龙江省博士后科学基金(LBH-Z15129);哈医大二院中青年创新科学研究基金(YKCX2018-15)。

摘　　要：目的探讨皮下注射粒细胞-巨噬细胞集落刺激因子(GM-CSF)对多发性骨髓瘤(MM)患者侵袭性真菌病(IFD)的预防效果。方法回顾性分析2015年1月至2021年6月哈尔滨医科大学附属第二医院收治的接受诱导化疗的222例初治MM患者的临床资料。患者均于中性粒细胞(ANC)≤1.5×10^(9)/L时应用GM-CSF(3~5μg·kg^(-1)·d^(-1),GM-CSF组)或粒细胞集落刺激因子(G-CSF,2~5μg·kg^(-1)·d^(-1),G-CSF组),白细胞计数(WBC)≥10.0×10^(9)/L时停用。比较两组患者IFD(包括确诊、临床诊断和拟诊)及突破性侵袭性真菌感染发生情况。结果所有患者中IFD发生率为8.1%(18/222)。GM-CSF组和G-CSF组IFD发生率分别为3.5%(3/85)和10.9%(15/137),两组差异有统计学意义(χ^(2)=3.88,P=0.049)。GM-CSF组接受真菌感染预防的9例及G-CSF组接受真菌感染预防的15例患者中,发生突破性侵袭性真菌感染分别为0、7例,两组差异有统计学意义(P=0.022)。结论MM患者应用GM-CSF可减少IFD和突破性侵袭性真菌感染的发生。Objective To explore the efficacy of subcutaneous injection of granulocyte-macrophage colony-stimulating factor(GM-CSF)in preventing invasive fungal disease(IFD)in patients with multiple myeloma(MM).Methods The clinical data of 222 patients who were admitted to the Second Hospital of Harbin Medical University from January 2015 to June 2021 were retrospectively analyzed.The patients was given GM-CSF(3-5μg·kg^(-1)·d^(-1),GM-CSF group)or granulocyte colony-stimulating factor(G-CSF,2-5μg·kg^(-1)·d^(-1),G-CSF group)when neutrophils(ANC)≤1.5×109/L after induction chemotherapy.Patients were discontinued when white blood cell count(WBC)≥10.0×109/L.The incidence of IFD(including confirmed,clinical and proposed diagnosis)and breakthrough invasive fungal infections was compared between the two groups.Results The incidence of IFD was 8.1%(18/222)in all patients.The incidence of IFD was 3.5%(3/85)and 10.9%(15/137)in the GM-CSF and G-CSF groups,respectively,and the difference between the two groups was statistically significant(χ^(2)=3.88,P=0.049).In 9 patients of GM-CSF group receiving fungal infection prophylaxis and in 15 patients of G-CSF group receiving fungal infection prophylaxis,the incidence of breakthrough invasive fungal infections was 0 and 7 cases,respectively,and the difference between the two groups was statistically significant(P=0.022).Conclusions GM-CSF application in MM patients can reduce the incidence of IFD and breakthrough invasive fungal infections.

关 键 词：多发性骨髓瘤 粒细胞巨噬细胞集落刺激因子 侵袭性真菌病 侵袭性真菌感染 

分 类 号：R733.3[医药卫生—肿瘤] R519[医药卫生—临床医学]