Cov Kev Cov nyom hauv kev kho mob kab mob fungal uas kis tau sai heev rau cov neeg mob qog ntshav: Kev nkag siab los ntawm ASH 2024

Xyoo 2024, ntawm lub Rooj Sib Tham Txhua Xyoo 66th ntawm American Society of Hematology (ASH) xyoo 2024, Xib Fwb Sun Yuqian los ntawm Peking University People's Hospital tau nthuav tawm ib txoj kev tshawb fawb tseem ceeb txog kev kis tus kab mob fungal (bIFD) hauv cov neeg mob uas tau hloov pauv allogeneic hematopoietic stem cell (allo-HSCT) hauv Suav teb. Txoj kev tshawb fawb no, uas tau ua thoob plaws 12 lub tsev kho mob, tau luam tawm hauv phau ntawv xov xwm raug cai ntawm Cov Kab Mob Sib Kis Lub Koom Haum Amelikas,Cov Kab Mob Sib Kis Hauv Tsev Kho Mob (CID).

Cov kev tshawb fawb, hu ua CAESAR 2.0 kev tshawb fawb, tsom mus rau 2,015 tus neeg laus tau txais allo-HSCT txij lub Ib Hlis mus txog rau lub Kaum Ob Hlis 2021. Nws tau qhia tias 76.08% ntawm cov neeg mob tau txais kev tiv thaiv kab mob fungal, feem ntau yog voriconazole (44.37%) thiab posaconazole (31.71%). Txawm hais tias muaj kev siv cov tshuaj tua kab mob fungal no dav dav, kev tshawb fawb pom tias muaj kev sib kis txhua xyoo ntawm cov kab mob fungal (IFD) ntawm 6.3%, nrog rau tus nqi tuag siab ntawm 48.28%. Candida, Aspergillus, thiab lwm yam fungi tau txheeb xyuas tias yog cov kab mob tseem ceeb uas ua rau muaj kev sib kis.

Xibfwb Sun kuj tau hais txog cov teeb meem kev kho mob uas cuam tshuam nrog kev kuaj mob thiab kho bIFD rau cov neeg mob ntshav tsis zoo. IFD uas tshwm sim thaum lub sijhawm tiv thaiv kab mob fungal, uas ua rau kev kuaj mob thiab kev kho mob nyuaj. Vim tsis muaj kev txhais lus txheem, tus nqi ntawm bIFD sib txawv heev, txij li 1% txog 42%. Qhov tsis sib xws no ua rau nws nyuaj rau tsim cov qauv kuaj mob thiab cov txheej txheem kho mob sib xws.

Ib qho ntawm cov teeb meem loj uas Xibfwb Sun tau hais txog yog qhov nyuaj ntawm cov yam ua rau muaj bIFD, uas suav nrog neutropenia ntev, siv tshuaj steroid, thiab siv ntau yam tshuaj tua kab mob ntev. Ntxiv mus, cov tshuaj tua kab mob uas siv rau kev tiv thaiv tej zaum yuav tsis npog tag nrho cov kab mob uas muaj peev xwm ua tau, thiab cov kab mob fungal uas tshwm sim tshiab yuav zam kev kuaj pom vim tias kev kuaj mob tsis zoo xws li PCR thiab GM tests.

Xibfwb Sun tau hais txog qhov tseem ceeb ntawm kev kho mob fungal thaum ntxov, tshwj xeeb tshaj yog rau cov neeg mob uas muaj kev pheej hmoo siab uas qhia cov tsos mob ntawm kev kis kab mob. Nws pom zoo tias kev kho mob fungal yuav tsum pib tam sim ntawd rau cov neeg mob uas muaj mob hnyav uas xav tias muaj bIFD, txawm tias ua ntej cov txiaj ntsig kuaj hauv chaw kuaj mob muaj. Nws kuj tau qhia kom siv cov tshuaj fungal uas txawv ntawm cov tshuaj prophylactic kom ua tau zoo tshaj plaws ntawm kev kho mob.

Cov kev tshawb pom ntawm CAESAR 2.0 txoj kev tshawb fawb qhia txog qhov xav tau cov tswv yim zoo dua los tswj kev pheej hmoo IFD hauv cov neeg mob allo-HSCT thiab qhov xav tau kev kuaj mob thaum ntxov thiab kev cuam tshuam sai. Raws li Xibfwb Sun xaus lus, thaum cov tshuaj tua kab mob uas twb muaj lawm tseem ua lub luag haujlwm tseem ceeb, kev tsim cov kev kho mob tshiab thiab cov cuab yeej kuaj mob yog qhov tseem ceeb rau kev txhim kho cov txiaj ntsig ntawm tus neeg mob. Cov kev kho mob tshiab, xws li Kev kho mob tiv thaiv kab mob thiab cov tshuaj tua kab mob tshiab, tej zaum yuav muab kev cia siab tshiab rau cov neeg mob uas tawm tsam cov kab mob txaus ntshai no.

Daim kev tshawb fawb tshiab no txog bIFD qhia txog cov teeb meem uas cov kws kho mob ntsib hauv kev tswj cov kab mob fungal hauv cov neeg mob hematologic malignancy thiab taw qhia rau qhov xav tau tseem ceeb rau kev nce qib tas mus li hauv kev tiv thaiv thiab kev kho mob.