侵袭性曲霉菌病 (IA) 的造血生长因子
细胞集落刺激因子 (G-CSF) 和人粒细胞-巨噬细胞集落刺激因子 (GM-CSF) 可适当减少中性粒细胞减少的持续时间。GM-CSF 可加强多形核白细胞的吞噬活性,对有急性髓性白血病合并 IA 的老年患者可起到重要的治疗作用。[105]Rowe JM, Andersen JW, Mazza JJ, et al. A randomized placebo-controlled phase III study of granulocyte-macrophage colony-stimulating factor in adult patients (>55 to 70 years of age) with acute myelogenous leukemia: a study of the Eastern Cooperative Oncology Group (E1490). Blood. 1995;86:457-462.http://bloodjournal.hematologylibrary.org/cgi/reprint/86/2/457http://www.ncbi.nlm.nih.gov/pubmed/7605984?tool=bestpractice.com集落刺激因子的作用:有中等质量的证据证明,对于有急性髓性白血病和侵袭性曲霉菌病的老年患者,粒细胞巨噬细胞集落刺激因子对此类患者具有一定的治疗作用。[105]Rowe JM, Andersen JW, Mazza JJ, et al. A randomized placebo-controlled phase III study of granulocyte-macrophage colony-stimulating factor in adult patients (>55 to 70 years of age) with acute myelogenous leukemia: a study of the Eastern Cooperative Oncology Group (E1490). Blood. 1995;86:457-462.http://bloodjournal.hematologylibrary.org/cgi/reprint/86/2/457http://www.ncbi.nlm.nih.gov/pubmed/7605984?tool=bestpractice.com 中性粒细胞的迅速恢复可引起炎症反应。可单独使用 GM-CSF 或与干扰素 γ 联合使用。[106]Wan L, Zhang Y, Lai Y, et al. Effect of granulocyte-macrophage colony-stimulating factor on prevention and treatment of invasive fungal disease in recipients of allogeneic stem-cell transplantation: a prospective multicenter randomized phase IV trial. J Clin Oncol. 2015;33:3999-4006.http://jco.ascopubs.org/content/33/34/3999.longhttp://www.ncbi.nlm.nih.gov/pubmed/26392095?tool=bestpractice.com 联合治疗可诱导由细胞因子介导的炎症过程而导致的临床应答,同时对有细胞介导的免疫损害的患者有效。
粒细胞输注用于治疗侵袭性曲霉菌病
粒细胞输注已被零星用于有长期中性粒细胞减少和重度真菌或细菌感染的患者,并取得了较好的疗效。预后因素包括足够数量的粒细胞输注、供者和受者的粒细胞兼容性和预期的骨髓恢复。供者可能需要接受皮质类固醇和 G-CSF 刺激治疗。[107]Atallah E, Schiffer CA. Granulocyte transfusion. Curr Opin Hematol. 2006;13:45-49.http://www.ncbi.nlm.nih.gov/pubmed/16319687?tool=bestpractice.com[108]Dignani MC, Anaissie EJ, Hester JP, et al. Treatment of neutropenia-related fungal infections with granulocyte colony-stimulating factor-elicited white blood cell transfusions: a pilot study. Leukemia. 1997;11:1621-1630.http://www.ncbi.nlm.nih.gov/pubmed/9324280?tool=bestpractice.com临床改善:有中等质量的证据证明,对有长期中性粒细胞减少和重度真菌或细菌感染的患者进行的供者粒细胞输注具有较好疗效。[107]Atallah E, Schiffer CA. Granulocyte transfusion. Curr Opin Hematol. 2006;13:45-49.http://www.ncbi.nlm.nih.gov/pubmed/16319687?tool=bestpractice.com[108]Dignani MC, Anaissie EJ, Hester JP, et al. Treatment of neutropenia-related fungal infections with granulocyte colony-stimulating factor-elicited white blood cell transfusions: a pilot study. Leukemia. 1997;11:1621-1630.http://www.ncbi.nlm.nih.gov/pubmed/9324280?tool=bestpractice.com
干扰素 γ 用于治疗侵袭性曲霉菌病
干扰素-γ 可增加先天性和 TH1-依赖性免疫。它已被证明可增加氧化迸发和增加多形核白细胞在体外抗烟曲霉菌菌丝的真菌活性。它也可恢复皮质类固醇引起的单核细胞和白细胞的免疫抑制活性。其化合物已被证明可对慢性肉芽肿性疾病患者有预防作用,同时在病历报告中,显示对 IA 患者采用联合其他细胞因子的治疗方法有较好疗效。[28]Gallin JI, Zarember K. Lessons about the pathogenesis and management of aspergillosis from studies in chronic granulomatous disease. Trans Am Clin Climatol Assoc. 2007;118:175-185.http://www.ncbi.nlm.nih.gov/pubmed/18528501?tool=bestpractice.com预防:有低质量证据证明,对于侵袭性曲霉菌病患者,使用干扰素 γ 联合其他细胞因子可成功预防疾病。[28]Gallin JI, Zarember K. Lessons about the pathogenesis and management of aspergillosis from studies in chronic granulomatous disease. Trans Am Clin Climatol Assoc. 2007;118:175-185.http://www.ncbi.nlm.nih.gov/pubmed/18528501?tool=bestpractice.com 几种其他细胞因子(白介素 [IL]-12、IL-15、IL-18 和趋化因子)可有望作为治疗侵袭性真菌感染的辅助治疗药物。[109]Anaissie EJ. Diagnosis and therapy of fungal infection in patients with leukemia-new drugs and immunotherapy. Best Pract Res Clin Haematol. 2008;21:683-690.http://www.ncbi.nlm.nih.gov/pubmed/19041608?tool=bestpractice.com