肿瘤细胞治疗研究
英文原题：Primary antifungal prophylaxis in hematological malignancies. Updated clinical practice guidelines by the European Conference on Infections in Leukemia (ECIL).
在第 10 届欧洲白血病感染会议（ECIL）上，针对血液系统恶性肿瘤（HM）儿童和成人患者的抗真菌预防指南得到更新，并引入了一些变更。
第10届欧洲白血病感染会议（ECIL）更新了血液系统恶性肿瘤患者（儿童及成人）的抗真菌预防指南，并作出若干调整。急性髓系白血病（AML）和骨髓增生异常综合征（MDS）患者接受缓解诱导化疗时，依据显示可预防侵袭性真菌病（IFD）的非随机研究，艾沙康唑、米卡芬净和卡泊芬净获B-II级推荐。高危MDS患者接受阿扎胞苷治疗时，文献支持在前4个治疗周期使用泊沙康唑预防。骨髓增殖性肿瘤、急性淋巴细胞白血病（ALL）和霍奇金淋巴瘤患者不建议预防；慢性淋巴细胞白血病及非霍奇金淋巴瘤患者通常也不建议预防。多发性骨髓瘤患者不建议抗真菌预防，现有有限流行病学数据也不支持双特异性抗体治疗患者常规预防。异基因造血干细胞移植患者的建议无实质变化，仅新增植入后使用艾沙康唑的B-II级推荐；自体移植患者不建议预防。既往ECIL指南未涵盖CAR-T细胞。专家组建议高危患者在CAR-T输注前后进行抗霉菌预防，低危患者可考虑抗酵母菌预防（B-II级）。根据新发表的数据，卡泊芬净在儿科血液病患者中获B-I级抗霉菌预防推荐；诱导治疗应答不足的ALL患儿以及12岁以上儿童也被列为IFD高危人群，建议接受抗真菌预防。
At the 10th European Conference on Infections in Leukaemia (ECIL), the guidelines for antifungal prophylaxis in pediatric and adult patients with hematological malignancies (HM) were updated and some changes introduced. Regarding acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) patients undergoing remission induction chemotherapy, a B-II grading has been assigned to isavuconazole, micafungin, and caspofungin, based on non-randomized studies that have shown efficacy in preventing invasive fungal diseases (IFD). Regarding high-risk MDS patients treated with azacytidine, prophylaxis with posaconazole during the first four cycles of treatment is supported in the literature. Prophylaxis is not indicated in patients treated for myeloproliferative neoplasms (NPM), acute lymphoid leukemia (ALL), and Hodgkin lymphoma (HL). For patients with chronic lymphocytic leukemia (CLL) and non-Hodgkin lymphoma (NHL), prophylaxis is not generally indicated. For patients with multiple myeloma (MM), prophylaxis is not indicated and the limited epidemiological data available do not support the use of prophylaxis in subjects treated with bispecific antibodies. For patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT), no substantial changes were made, apart from the addition of isavuconazole with grading B-II in the post-engraftment period. In patients undergoing auto-HSCT, antifungal prophylaxis is not indicated. Previous ECIL guidelines did not include CAR-T cells. The expert panel proposes to endorse the use of anti-mold prophylaxis in high-risk patients during pre-infusion and post-infusion, while in low-risk patients, anti-yeast prophylaxis can be recommended (B-II). For pediatric hematology patients, based on newly published data, caspofungin received a B-I grading as mold-active prophylaxis. Moreover, patients with ALL with insufficient treatment response during induction therapy, and children older than 12 y.o are now considered at high risk for IFD and are recommended to receive antifungal prophylaxis.
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