急性白血病の化学療法後に合併する感染症対策の現状 Japan Adult Leukemia Study Groupの実態調査の解析
Japan Adult Leukemia Study Group (JALSG) における急性白血病治療時の感染症対策の実態調査アンケートの結果を報告する。調査は2001年秋に行い, JALSG参加全196施設中125施設 (64%) から回答が得られた。細菌感染予防はpolymixin B (31%) とニューキノロン薬 (38%) が, 真菌感染予防はfluconazole (FLCZ, 41%) とamphotericin B (AMPH-B, 42%) が多く, 予防はそれぞれ6%と3%にすぎなかった。Febrile neutropeniaのEmpiric therapy (ET) は...
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| Published in | 日本化学療法学会雑誌 Vol. 51; no. 11; pp. 703 - 710 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
公益社団法人 日本化学療法学会
25.11.2003
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-7007 1884-5886 |
| DOI | 10.11250/chemotherapy1995.51.703 |
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| Abstract | Japan Adult Leukemia Study Group (JALSG) における急性白血病治療時の感染症対策の実態調査アンケートの結果を報告する。調査は2001年秋に行い, JALSG参加全196施設中125施設 (64%) から回答が得られた。細菌感染予防はpolymixin B (31%) とニューキノロン薬 (38%) が, 真菌感染予防はfluconazole (FLCZ, 41%) とamphotericin B (AMPH-B, 42%) が多く, 予防はそれぞれ6%と3%にすぎなかった。Febrile neutropeniaのEmpiric therapy (ET) はcephemやcarbapenemの単剤療法が35%で, それらとアミノ配糖体との併用療法が50%で行われていた。Vancomycinを初期から使用する施設は1%であった。ETが無効の場合は3～4日後に51%の施設が抗真菌薬を追加しており, 薬剤はFLCZ (66%) がAMPH-B (28%) より多かった。真菌症の治療はカンジダ敗血症は比較的安定した病状ではFLCZが (59%), 肺炎の合併や病状が不安定な場合にはAMPH-B (57%) が選択された。一方アスペルギルス症ではAMPH-Bが用いられるが, 投与量は0.5～0.7mg/kgが44%で, 本症の治療で推奨される1mg/kg以上を使用する施設は42%であった。顆粒球コロニー刺激因子は急性骨髄性白1血1病ではlife threatening infectionの場合に投与がもっとも多かったが (27%), 急性リンパ性白血病では発熱前の予防的投与が多かった (52%)。以上の結果は今後, わが国の好中球減少患者の感染症治療ガイドラインを作成する際に参考になると考えられた。 |
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| AbstractList | Japan Adult Leukemia Study Group (JALSG) における急性白血病治療時の感染症対策の実態調査アンケートの結果を報告する。調査は2001年秋に行い, JALSG参加全196施設中125施設 (64%) から回答が得られた。細菌感染予防はpolymixin B (31%) とニューキノロン薬 (38%) が, 真菌感染予防はfluconazole (FLCZ, 41%) とamphotericin B (AMPH-B, 42%) が多く, 予防はそれぞれ6%と3%にすぎなかった。Febrile neutropeniaのEmpiric therapy (ET) はcephemやcarbapenemの単剤療法が35%で, それらとアミノ配糖体との併用療法が50%で行われていた。Vancomycinを初期から使用する施設は1%であった。ETが無効の場合は3～4日後に51%の施設が抗真菌薬を追加しており, 薬剤はFLCZ (66%) がAMPH-B (28%) より多かった。真菌症の治療はカンジダ敗血症は比較的安定した病状ではFLCZが (59%), 肺炎の合併や病状が不安定な場合にはAMPH-B (57%) が選択された。一方アスペルギルス症ではAMPH-Bが用いられるが, 投与量は0.5～0.7mg/kgが44%で, 本症の治療で推奨される1mg/kg以上を使用する施設は42%であった。顆粒球コロニー刺激因子は急性骨髄性白1血1病ではlife threatening infectionの場合に投与がもっとも多かったが (27%), 急性リンパ性白血病では発熱前の予防的投与が多かった (52%)。以上の結果は今後, わが国の好中球減少患者の感染症治療ガイドラインを作成する際に参考になると考えられた。 |
| Author | 松島, 孝文 吉田, 稔 竹内, 仁 秋山, 暢 内藤, 健助 程原, 佳子 高橋, 正知 田口, 博國 松田, 光弘 |
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| References | 6) Pizzo P A: Empiric therapy and prevention of infection in the immunocompromised host. Mandell G L, et al.(eds) Principles and practice of infectious diseases 5 th edn, p.31O2-3112, Churchill Livingstone Inc., New York, 2000 7) Cruciani M, Rampazzo R, Malena M, et al.: Prophylaxis with Fluoroquinolones for bacterial infections in neutropenic patients: a meta-analysis. Clin Infect Dis 23: 795-805, 1996 1) De Pauw B E, Meunier F: Infections in patients with acute leukemia and lymphoma. Mandell G L, et al.(eds) Principles and practice of infectious diseases 5 th edn, p.3090-3102, Churchill Livingstone Inc., New York, 2000 14) Rex J H, Walsh T J, Sobel J D, et al.: Practice guidelines for the treatment of candidiasis. Infectious diseases society of America. Clin Infect Dis 30: 662-678, 2000 16) Lowenberg B, Touw I T: Hematopoietic growth factors and their receptors in acute leukemia. Blood 81: 281-92, 1993 11) Pizzo P A, Hathorn J W, Hiemenz J, et al.: A randomized trial comparing ceftazidime alone with combination antibiotic therapy in cancer patients with fever and neutropenia. N Engl J Med 315: 552-558, 1986 13) Viscoli C, Castagnola E, VanLint M T, et al.: Fluconazole versus amphotericin B as empirical antifungal therapy of unexplained fever in granulocytopenic cancer patients: a pragmatic, multicentre, prospective and randomized clinical trial. Eur J Cancer 32 A: 814-820, 1996 2) Yoshida M, Tsubaki K, Kobayashi T, et al.: Infectious complications during remission induction therapy in 577 patients with acute myeloid leukemia in the Japan Adult Leukemia Study Group studies between 1987 and 1991. Int J Hematol 70: 261-267, 1999 12) Tamura K, Matsuoka H, Tsukada J, et al.: Cefepime or carbapenem treatment for febrile neutrpopenia as a single agent is as effective as a combination of 4thgeneration cephalosporin+ aminoglycoside: comparative study. Am J Hematol 71: 248-255, 2002 9) Kanda Y, Yamamoto R, Chizuka A, et al.: Prophylactic action of oral fluconazole against fungal infection in neutropenic patients. A metaanalysis of 16 randomized, controlled trials. Cancer 89: 1611-1625, 2000 10) Urabe A, Takaku F, Mizoguchi H, et al.: Prophylactic and therapeutic effects of oral administration of amphotericin B in mycosis associated with hematological diseases. Jpn J Antibiotics 43: 116 130, 1990 8) Goodman J L, Winston D J, Greenfield A, et al.: A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantations. N Engl J Med 326: 845-851, 1992 20) Masaoka T: Evidence-based recommendations on antimicrobial use in febrile neutropenia in Japan. Int J Hematol 68 (suppl 1): 1-40, 1998 17) Maher D W, Lieschke G J, Green M, et al.: Filgrastim in patients with chemotherapy-induced febrile neutropenia: a double-blind, placebocontrolled trial. Ann Intern Med 121: 492-501, 1994 3) Hughes W T, Armstrong D, Bodey G P, et al.: 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34: 730-751, 2002 15) Stevens D A, Kan V L, Judson M A, et al.: Practice guidelines for diseases caused by Aspergillus. Infectious diseases society of America. Clin Infect Dis 30: 696-709, 2000 5) Murphy M E. Sepkowitz K A, Armstrong D: Prevention of infection in patients with hematologic malignancy. Wiernik P H, et al.(eds), Neoplastic Diseases of the Blood, p.1007-1025, Churchill Livingstone Inc., New York, 1996 19) Yoshida M, Karasawa M, Naruse T, et al.: Effect of granulocyte-colony stimulating factor on empiric therapy with flomoxef sodium and tobramycin in febrile neutropenic patients with hematological malignancies. Int J Hematol 69: 81-88, 1999 4) Ozer H, Armitage J 0, Bennett C L, et al.: 2000 update of recommendations for the use of hematopoietic colony-stimulating factors: evidence-based, clinical practice guidelines. J CIin Oncol 18: 3558-3585, 2000 18) Mitchell P L, Morland B, Stevens M C, et al.: Granulocyte colony-stimulating factor in established febrile neutropenia: a randomized study of pediatric patients. J Clin Oncol 15: 1163-1170, 1997 |
| References_xml | – reference: 14) Rex J H, Walsh T J, Sobel J D, et al.: Practice guidelines for the treatment of candidiasis. Infectious diseases society of America. Clin Infect Dis 30: 662-678, 2000 – reference: 5) Murphy M E. Sepkowitz K A, Armstrong D: Prevention of infection in patients with hematologic malignancy. Wiernik P H, et al.(eds), Neoplastic Diseases of the Blood, p.1007-1025, Churchill Livingstone Inc., New York, 1996 – reference: 1) De Pauw B E, Meunier F: Infections in patients with acute leukemia and lymphoma. Mandell G L, et al.(eds) Principles and practice of infectious diseases 5 th edn, p.3090-3102, Churchill Livingstone Inc., New York, 2000 – reference: 9) Kanda Y, Yamamoto R, Chizuka A, et al.: Prophylactic action of oral fluconazole against fungal infection in neutropenic patients. A metaanalysis of 16 randomized, controlled trials. Cancer 89: 1611-1625, 2000 – reference: 18) Mitchell P L, Morland B, Stevens M C, et al.: Granulocyte colony-stimulating factor in established febrile neutropenia: a randomized study of pediatric patients. J Clin Oncol 15: 1163-1170, 1997 – reference: 20) Masaoka T: Evidence-based recommendations on antimicrobial use in febrile neutropenia in Japan. Int J Hematol 68 (suppl 1): 1-40, 1998 – reference: 13) Viscoli C, Castagnola E, VanLint M T, et al.: Fluconazole versus amphotericin B as empirical antifungal therapy of unexplained fever in granulocytopenic cancer patients: a pragmatic, multicentre, prospective and randomized clinical trial. Eur J Cancer 32 A: 814-820, 1996 – reference: 2) Yoshida M, Tsubaki K, Kobayashi T, et al.: Infectious complications during remission induction therapy in 577 patients with acute myeloid leukemia in the Japan Adult Leukemia Study Group studies between 1987 and 1991. Int J Hematol 70: 261-267, 1999 – reference: 4) Ozer H, Armitage J 0, Bennett C L, et al.: 2000 update of recommendations for the use of hematopoietic colony-stimulating factors: evidence-based, clinical practice guidelines. J CIin Oncol 18: 3558-3585, 2000 – reference: 8) Goodman J L, Winston D J, Greenfield A, et al.: A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantations. N Engl J Med 326: 845-851, 1992 – reference: 19) Yoshida M, Karasawa M, Naruse T, et al.: Effect of granulocyte-colony stimulating factor on empiric therapy with flomoxef sodium and tobramycin in febrile neutropenic patients with hematological malignancies. Int J Hematol 69: 81-88, 1999 – reference: 10) Urabe A, Takaku F, Mizoguchi H, et al.: Prophylactic and therapeutic effects of oral administration of amphotericin B in mycosis associated with hematological diseases. Jpn J Antibiotics 43: 116 130, 1990 – reference: 11) Pizzo P A, Hathorn J W, Hiemenz J, et al.: A randomized trial comparing ceftazidime alone with combination antibiotic therapy in cancer patients with fever and neutropenia. N Engl J Med 315: 552-558, 1986 – reference: 15) Stevens D A, Kan V L, Judson M A, et al.: Practice guidelines for diseases caused by Aspergillus. Infectious diseases society of America. Clin Infect Dis 30: 696-709, 2000 – reference: 3) Hughes W T, Armstrong D, Bodey G P, et al.: 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34: 730-751, 2002 – reference: 12) Tamura K, Matsuoka H, Tsukada J, et al.: Cefepime or carbapenem treatment for febrile neutrpopenia as a single agent is as effective as a combination of 4thgeneration cephalosporin+ aminoglycoside: comparative study. Am J Hematol 71: 248-255, 2002 – reference: 6) Pizzo P A: Empiric therapy and prevention of infection in the immunocompromised host. Mandell G L, et al.(eds) Principles and practice of infectious diseases 5 th edn, p.31O2-3112, Churchill Livingstone Inc., New York, 2000 – reference: 7) Cruciani M, Rampazzo R, Malena M, et al.: Prophylaxis with Fluoroquinolones for bacterial infections in neutropenic patients: a meta-analysis. Clin Infect Dis 23: 795-805, 1996 – reference: 16) Lowenberg B, Touw I T: Hematopoietic growth factors and their receptors in acute leukemia. Blood 81: 281-92, 1993 – reference: 17) Maher D W, Lieschke G J, Green M, et al.: Filgrastim in patients with chemotherapy-induced febrile neutropenia: a double-blind, placebocontrolled trial. Ann Intern Med 121: 492-501, 1994 |
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| Snippet | Japan Adult Leukemia Study Group (JALSG) における急性白血病治療時の感染症対策の実態調査アンケートの結果を報告する。調査は2001年秋に行い, JALSG参加全196施設中125施設 (64%) から回答が得られた。細菌感染予防はpolymixin B (31%)... |
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| SubjectTerms | 感染予防 真菌感染症 顆粒球コロニー刺激因子 |
| Subtitle | Japan Adult Leukemia Study Groupの実態調査の解析 |
| Title | 急性白血病の化学療法後に合併する感染症対策の現状 |
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