Empirical versus diagnostic-driven antifungal therapy for hematological malignancies patients with invasive fungal disease

Abstract

Objective To compare the clinical efficacy of empirical therapy and diagnostic-driven the-rapy in the treatment of the hematological malignancies patients complicated with invasive fungal disease (IFD). Methods The clinical data of patients with hematological malignancies undergoing antifungal treatment in the Department of Hematology and Lymphoma of Cancer Hospital & Shenzhen Hospital, Chinese Aca-demy of Medical Sciences and Peking Union Medical College from August 2017 to August 2018 were analyzed retrospectively. A total of 68 patients met the inclusion criteria, of which, 28 received the empirical therapy and 40 received the diagnostic-driven therapy. Then the differences of the incidence of IFD, IFD-related mortality, days of hospitalization and antifungal treatment between the two groups were compared. Results The incidence of IFD in the diagnostic-driven therapy group was higher than that in the empirical therapy group [27.5% (11/40) vs. 7.1% (2/28), χ2=4.414, P=0.036]. While the rates of IFD-related mortality were 7.5% (3/40) and 3.6% (1/28) respectively, with no statistically significant difference (χ2=0.459, P=0.498). The number of antifungal treatment days in the diagnostic-driven therapy group was greater than that in the empirical therapy group [(15.9±3.3) d vs. (13.1±2.5) d, t=-3.654, P=0.001]. While the numbers of hospitalization days were similar in the two groups [(20.1±2.1) d vs. (19.4±2.3) d], with no statistically significant difference (t=-1.273, P=0.208). Conclusion Both diagnostic-driven therapy and empirical therapy are helpful to early antifungal treatment, and they should be performed properly combined with the actual clinical conditions. Key words: Hematologic neoplasms; Mycoses; Therapy