Yonsei Med J.  2014 Jan;55(1):9-18. 10.3349/ymj.2014.55.1.9.

Clinical Outcomes and Prognostic Factors of Empirical Antifungal Therapy with Itraconazole in the Patients with Hematological Malignancies: A Prospective Multicenter Observational Study in Korea

Affiliations
  • 1Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea. minbrmmd@yuhs.ac
  • 2Department of Hematology/Oncology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
  • 3Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
  • 4Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 5Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
  • 6Department of Internal Medicine, Busan Paik Hospital, Inje University, Busan, Korea.
  • 7Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
  • 8Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea.
  • 9Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.
  • 10Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea.
  • 11Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.
  • 12Department of Hematology-Oncology, Kyungpook National University Hospital, Daegu, Korea.
  • 13Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, Korea.
  • 14Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.

Abstract

PURPOSE
To identify prognostic factors for the outcomes of empirical antifungal therapy, we performed a multicenter, prospective, observational study in immunocompromised patients with hematological malignancies.
MATERIALS AND METHODS
Three hundred seventy-six patients (median age of 48) who had neutropenic fever and who received intravenous (IV) itraconazole as an empirical antifungal therapy for 3 or more days were analyzed. The patients with possible or probable categories of invasive fungal disease (IFD) were enrolled.
RESULTS
The overall success rate was 51.3% (196/376). Age >50 years, underlying lung disease (co-morbidity), poor performance status [Eastern Cooperative Oncology Group (ECOG) > or =2], radiologic evidence of IFD, longer duration of baseline neutropenic fever (> or =4 days), no antifungal prophylaxis or prophylactic use of antifungal agents other than itraconazole, and high tumor burden were associated with decreased success rate in univariate analysis. In multivariate analysis, age >50 years (p=0.009) and poor ECOG performance status (p=0.005) were significantly associated with poor outcomes of empirical antifungal therapy. Twenty-two patients (5.9%) discontinued itraconazole therapy due to toxicity.
CONCLUSION
We concluded that empirical antifungal therapy with IV itraconazole in immunocompromised patients is effective and safe. Additionally, age over 50 years and poor performance status were poor prognostic factors for the outcomes of empirical antifungal therapy with IV itraconazole.

Keyword

Hematological malignancy; prognosis; itraconazole; empirical antifungal therapy
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