血液系统肿瘤患者泊沙康唑口服悬液预防后突破性侵袭性真菌病的发生及防治策略

Occurrence and control of breakthrough invasive fungal disease after prophylaxis with posaconazole oral suspension in patients with hematological malignancy

由于放/化疗、造血干细胞移植、免疫抑制剂等广泛应用于血液系统肿瘤(hematological malignancy,HM)患者的治疗,使得这些患者侵袭性真菌感染(invasive fungal infection,IFI)的发病率和致死率呈上升趋势。IFI通常起病隐匿、进展迅速、诊断困难,是威胁血液系统肿瘤患者的严重并发症之一,泊沙康唑属于第二代三唑类抗真菌药物,抗菌谱较广,被广泛用于血液系统肿瘤患者侵袭性真菌病(invasive fungal disease,IFD)的预防,极大地减少了患者IFD的发生。由于多种因素可影响泊沙康唑口服悬液的吸收、分布、和代谢和清除,导致泊沙康唑血药浓度不能达到预防目标浓度,故仍常有患者发生真菌突破感染。如何预防和治疗泊沙康唑口服悬液预防后突破性真菌感染,目前国内外尚缺乏统一共识,本文拟对泊沙康唑口服悬液预防后真菌突破的发生及防治策略做一综述。

Hematopoietic stem cell transplantation(HSCT) and immunosuppressants are widely used for treating patients with hematological malignancy(HM);however, the incidence and mortality of invasive fungal disease(IFD) in these patients are increasing. IFD usually has hidden onset, rapid progress, and difficult diagnosis and thus becomes aserious complication that threatens patients with hematological tumors. Posaconazole, a second-generation triazole antifungal drug with a wide antibacterial spectrum, greatly reduces the incidence of IFD among patients with hematological tumors. Because many factors can affect the absorption, distribution, metabolism, and clearance of posaconazole oral suspension, its blood concentration cannot reach the prevention target;hence, fungal breakthrough infections often occur. Consensus on how to prevent and treat breakthrough IFD after prophylaxis with posaconazole oral suspension is currently lacking. This review intends to summarize the occurrence of and prevention strategies for breakthrough IFD after oral posaconazole suspension prevention.