Imingeni ekunyangeni ukwahlukana kweSifo seFungal esihlaselayo kwiZigulana zeHematologic Malignancy: Iingcinga ezivela kwi-ASH 2024
KwiNtlanganiso yoNyaka yama-66 ye-American Society of Hematology (ASH) ngo-2024, uNjingalwazi uSun Yuqian wasePeking University People's Hospital ubonise uphando olubalulekileyo malunga nesifo sefungus esihlaselayo (bIFD) kwizigulana ezifakelwa i-allogeneic hematopoietic stem cell transplantation (allo-HSCT) eTshayina. Olu phononongo, olwenziwe kwizibhedlele ezili-12, lupapashwe kwijenali esemthethweni ye Izifo Ezisulelayo Umbutho waseMelika,Izifo Ezisulelayo Zezonyango (I-CID).
Olu phando, olwaziwa ngokuba luphando lwe-CAESAR 2.0, lugxile kubantu abadala abangama-2,015 abafumene i-HSCT ukususela ngoJanuwari ukuya kuDisemba 2021. Lutyhile ukuba ama-76.08% ezigulana afumene unyango lokulwa ne-fungus, ikakhulu i-voriconazole (44.37%) kunye ne-posaconazole (31.71%). Nangona la mayeza okulwa ne-fungus esetyenziswa kakhulu, olu phando lufumanise ukuba ukwanda kwesifo sokulwa ne-fungus (IFD) ngonyaka yi-6.3%, kunye nezinga eliphezulu lokufa elibangelwa yi-48.28%. I-Candida, i-Aspergillus, kunye nezinye iifungi zichongiwe njengezona zifo ziphambili ezibangela usulelo.
UNjingalwazi Sun ukwathethe ngemingeni yezonyango enxulumene nokuxilonga nokunyanga i-bIFD kwizigulane ezine-hematologic mold. Ukuphumelela kwe-IFD kwenzeka ngexesha lokuthintela ukubola kwe-antifungal, nto leyo eyenza kube nzima ukuxilongwa kunye nonyango. Ngenxa yokungabikho kwenkcazo eqhelekileyo, amazinga okusasazeka kwe-bIFD ahluka kakhulu, ukusuka kwi-1% ukuya kwi-42%. Oku kungangqinelani kwenza kube nzima ukumisela iikhrayitheriya zokuxilonga ezihambelanayo kunye neenkqubo zonyango.
Enye yeengxaki ezinkulu ezigxininiswe nguNjingalwazi Sun kubunzima bezinto ezibangela umngcipheko kwi-bIFD, eziquka i-neutropenia ende, ukusetyenziswa kwee-steroid, kunye nokusetyenziswa ixesha elide kwee-antibiotics ezininzi. Ngaphezu koko, amayeza okubola asetyenziselwa ukuthintela asenokungasoloko egubungela uluhlu olupheleleyo lweentsholongwane ezinokubakho, kwaye iintlobo zefungus ezikhulayo zinokuphepha ukubonwa ngenxa yokuncipha kobuthathaka kwiimvavanyo zokuxilonga ezifana novavanyo lwe-PCR kunye ne-GM.
UNjingalwazi Sun ugxininise ukubaluleka konyango lokubola kwangethuba, ingakumbi kwizigulana ezisengozini enkulu ezibonisa iimpawu zosulelo. Ucebise ukuba unyango lokubola olusebenzisa i-empiric luqalwe ngoko nangoko kwizigulana ezigula kakhulu ezirhanelwa ukuba zine-bIFD, nangaphambi kokuba kufumaneke iziphumo zelebhu. Ucebise nokusetyenziswa kwamayeza okubola ahlukileyo kwindlela yokuthintela ukuze kuphuculwe ukusebenza konyango.
Iziphumo zophando lwe-CAESAR 2.0 zigxininisa imfuneko yezicwangciso eziphuculweyo zokulawula umngcipheko we-IFD kwizigulane ezine-HSCT kunye nemfuneko engxamisekileyo yokuxilongwa kwangethuba kunye nokungenelela. Njengoko uNjingalwazi Sun equkumbele, ngelixa ii-antifungal agents ezikhoyo ziqhubeka nokudlala indima ebalulekileyo, ukuphuhliswa kweendlela ezintsha zonyango kunye nezixhobo zokuxilonga kubalulekile ekuphuculeni iziphumo zezigulane. Unyango oluvelayo, olufana nolu Unyango lwe-immunotherapy kunye neearhente ezintsha zokubola, zinokubonelela ngethemba elitsha kwizigulana ezilwa nezi zifo zisongela ubomi.
Olu phando lubalaseleyo kwi-bIFD lubonisa imingeni eqhubekayo ejongene noogqirha ekulawuleni usulelo lwefungus kwizigulana ezine-hematologic mold kwaye lubonisa isidingo esibalulekileyo sokuqhubela phambili okuqhubekayo kwizicwangciso zokuthintela kunye nezonyango.