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Análisis de los factores de riesgo clave para infecciones fúngicas invasoras en pacientes onco-hematológicos: estudio Delphi

2017; Volume: 30; Issue: 2 Linguagem: Espanhol

1130-331X

Lourdes Vázquez, Miguel Salavert, Jorge Gayoso, Manuel Lizasoaín, Isabel Ruiz‐Camps, Nicolás Di Benedetto,

Fungal Infections and Studies

espanolIntroduccion. La mortalidad por infecciones fungicas invasoras por hongos filamentosos (IFI-HF) es elevada. Los factores predisponentes de IFI-HF son multiples y deben ser estratificados. El objetivo de este estudio fue identificar factores de riesgo clave para IFI-HF en pacientes onco-hematologicos en diversos contextos clinicos. Metodos. Estudio Delphi, nacional y prospectivo. Mediante revision sistematica de la literatura se identificaron los factores de riesgo de IFI-HF en pacientes con patologia onco-hematologica. Se envio por correo electronico una encuesta anonima a un panel de expertos. Se definio factor de riesgo clave cuando al menos el 70% de los encuestados le asignaba un riesgo “maximo” o “alto”. Resultados. Los factores de riesgo considerados clave fueron: en trasplante alogenico de progenitores hematopoyeticos 18/42 analizados (neutropenia, IFI-HF previa, enfermedad injerto contra huesped aguda III-IV o cronica extensa, trasplante de cordon umbilical, trasplante HLA incompatible, fracaso del injerto, ausencia filtros HEPA, ausencia flujo laminar, diagnostico de leucemia aguda mieloblastica, trasplante haploidentico, anti-TNF-α, alemtuzumab, globulina antitimocitica, profilaxis inmunosupresora para enfermedad injerto contra huesped, linfocitopenia, citomegalovirus y proximidad a construcciones). En LA/SMD 7/25 (neutropenia, consolidacion sin respuesta, IFI-HF previa, induccion, profilaxis con “azoles”, proximidad a construcciones y ausencia filtros HEPA). En linfoma/MM 5/21 analizados (esteroides, neutropenia, enfermedad en progresion, terapias anti-CD52 y proximidad a construcciones). Conclusiones. El metodo Delphi ha demostrado ser util para clasificar los factores de riesgo de IFI-HF en pacientes con patologia onco-hematologica. La identificacion de factores de riesgo clave permitira adecuar el manejo de IFI-HF en este grupo de pacientes con riesgo alto o cambiante. EnglishIntroduction. Mortality caused by invasive fungal infections due to filamentous fungi (IFI-FF) is high. Predisposing factors to IFI-FF are multiple and should be stratified. The objective of this study was to identify key risk factors for IFI-FF in onco-haematological patients in different clinical settings. Methods. Prospective national Delphi study. Risk factors for IFI-FF in patients with onco-haematological diseases were identified by a systematic review of the literature. An anonymous survey was sent by e-mail to a panel of experts. A key risk factor was defined when at least 70% of the surveyed participants assigned a “maximal” or “high” risk. Results. In allogenic stem cell transplantation, 18 of the 42 risk factors analyzed were classified as key risk factors, including neutropenia, previous IFI-FF, grade III/IV acute or extensive chronic graft-versus-host disease (GVHD), umbilical cord blood transplantation, HLA mismatching transplantation, graft failure, absence of HEPA filters, absence of laminar air flow, diagnosis of acute myeloid leukaemia, haploidentical transplantation, anti-TNF-α drugs, alemtuzumab, anti-thymocyte globulin, immunosuppressive prophylaxis for GVHD, lymphocytopenia, cytomegalovirus infection, and proximity to construction areas. In acute leukaemia/myelodysplastic syndrome (AL/MDS), 7 of 25 risk factors were defined as key risk factors, including neutropenia, consolidation therapy without response, induction therapy, antifungal prophylaxis with azoles, proximity to construction areas, and absence of HEPA filters. In lymphoma/multiple myeloma (MM), the five key risk factors among 21 analyzed were use of steroids, neutropenia, progressive disease, anti-CD52 therapies, and proximity to construction areas. Conclusions. The Delphi method was useful for the classification and stratification of risk factors for IFI-FF in patients with onco-haematological diseases. Identifying key risk factors will contribute to a better management of IFI-FF in this group of patients at high or changing risk.