急性白血病化疗后合并毛霉菌感染患者的临床特征及预后

Clinical Characteristics and Prognosis of Patients with Acute Leukemia Complicated with Mucormycosis after Chemotherapy

目的:分析急性白血病化疗后并发毛霉菌病患者的临床特点及预后,加强对该病的认识。方法:收集2021年10月至2022年6月在蚌埠医学院第一附属医院接受化疗后经宏基因组二代测序(mNGS)诊断为毛霉菌病的7例急性白血病患者,回顾性分析患者的临床资料,包括临床特征、诊疗经过和预后。结果:入组的7例患者中,男性3例,女性4例,中位年龄52(20-59)岁,急性髓系白血病(AML)6例,急性淋巴细胞白血病(ALL)1例。肺外参与4例,其中疑似中枢神经系统1例。毛霉菌感染发生的中位时间在启动化疗后16(6-69)d,粒细胞缺乏后19(14-154)d;临床表现无特异性,主要表现为发热(7/7)、咳嗽(3/7)、胸痛(3/7)、呼吸困难(1/7)。最常见的胸部CT影像学表现以结节、斑片状或团块实变影为主(6/7)。所有患者粒细胞缺乏期均使用泊沙康唑或伏立康唑预防治疗。5例患者在8个月内死亡,从确诊到死亡的中位时间为1个月。结论:急性白血病患者粒细胞缺乏期,虽然采取预防性抗真菌治疗,但仍然有感染毛霉菌的风险。毛霉菌感染初期均以发热为主要表现。发生毛霉菌感染的急性白血病患者单纯使用静脉抗真菌药物效果不佳,致死率高。

Objective:To analyze the characteristics and prognosis of patients with mucormycosis after chemotherapy for acute leukemia,and to strengthen understanding of the disease.Methods:7 cases of acute leukemia(AL)patients diagnosed with mucormycosis by metagenomic next generation sequencing(mNGS)after chemotherapy at the First Affiliated Hospital of Bengbu Medical College from October 2021 to June 2022 were collected,and their clinical data,including clinical characteristics,diagnosis,treatment,and prognosis,were retrospectively analyzed.Results:Among the 7 patients with AL complicated with mucormycosis,there were 3 males and 4 females,with a median age of 52(20-59)years.There were 6 cases of acute myeloid leukemia(AML)and 1 case of acute lymphocytic leukemia(ALL).Extrapulmonary involvement in 4 cases,including 1 case suspected of central nervous system involvement.The median time for the occurrence of mucor infection was 16(6-69)days after chemotherapy and 19(14-154)days after agranulocytosis.The main clinical manifestations of mucormycosis were fever(7/7),cough(3/7),chest pain(3/7)and dyspnea(1/7).The most common chest CT imaging findings were nodules,patchy or mass consolidation(6/7).All patients were treated with posaconazole or voriconazole prophylaxis during neutropenia phase.5 patients died within 8 months,and the median time from diagnosis to death was 1 month.Conclusion:Although prophylactic antifungal therapy is adopted,patients with acute leukemia still have a risk of mucor infection during the neutropenia phase.Fever is the main manifestation in the early stage of mucor infection.The use of intravenous antifungal drugs alone is ineffective and there is a high mortality rate in acute leukemia patients with mucormycosis.