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

• Kim JS
• Cheong JW
• Shin HJ
• Lee JW
• Lee JH
• Yang DH
• Lee WS
• Kim H
• Park JS
• Kim SH
• Kim YS
• Kwak JY
• Chae YS
• Park J
• Do YR
• Min YH

• KMID: 1779880
• DOI: http://doi.org/10.3349/ymj.2014.55.1.9

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

MeSH Terms

Antifungal Agents/adverse effects/*therapeutic use
Female
Hematologic Neoplasms
Humans
Immunocompromised Host
Itraconazole/adverse effects/*therapeutic use
Male
Middle Aged
Prospective Studies
Republic of Korea
Antifungal Agents
Itraconazole

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