Application Of The 2008 Definitions For Invasive Fungal Diseases To The Voriconazole vs Amphotericin B For Therapy Of Invasive Aspergillosis Trial. A Collaborative EORTC / MSG Study (MSG 05)

Ref ID: 18691

Author:

R. Herbrecht, MD – Professor1, T. F. Patterson, MD – Professor 2, M. A. Slavin, MD – Professor 3, O. Marchetti, MD – Professor 4, J. Maertens, MD – Professor 5, H. T. Schlamm, MD – Medical Director 6, J. P. Donnelly, PhD – Professor 7, P. G. Pappas,

Author address:

1CHU, Strasbourg, France, 2UTHSC and STVHCS, San Antonio, TX, 3Peter MacCallum Cancer Ctr., Melbourne, Australia, 4CHUV/Univ., Lausanne, Switzerland, 5UZ Gasthuisberg, K.U.Leuven, Leuven, Belgium, 6Pfizer, New York, NY, 7Radboud Univ Med Ctr, Nijmege

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: The EORTC/MSG revised the criteria for defining invasive fungal diseases in 2008. We assessed their impact on the original classification and outcomes at entry in the VRZ vs AmB for primary therapy of IA clinical trial (NEJM, 2002, 347:408). Methods: Baseline clinical and microbiological data for 397 pts enrolled in the original study were provided to 5 reviewers, blinded to study treatment. Serum galactomannan results, performed in 249 pts after original analysis, were incorporated and outcome was assessed again after recategorization. Results: Using the original definitions, 277 pts had probable or proven IA. Using the revised definitions, 105 had possible IA, 174 had probable IA, and 59 had proven IA. Original classification was unchanged in 185 and changed in 194 cases. Reasons for change were: downgraded from definite to probable in 47 (24.2%) based on positive BAL only, downgraded from probable to possible in 65 (33.5%) based on nodule with halo and no mycology, upgraded from not aspergillosis or uncertain to possible in 40 (20.6%) based on nodule without halo and no mycology, upgraded from uncertain to probable in 20 (10.3%) based on nodule without halo and positive mycology. In pts with possible, probable or proven IA, response rate at end of randomized therapy was higher for VRZ (54.2%) vs 29.8% for AmB, P<0.0004. Survival at week 12 was higher for VRZ in pts with probable or proven IA (VRZ: 69.9%; AmB: 55.5%; P = 0.014) but not for possible IA (VRZ 79.6%, AmB 68.6%; P = 0.18). Conclusions: Application of the revised criteria does not change the outcomes originally reported. Moreover, this analysis generated new data regarding the outcome of antifungal treatment in pts with a diagnosis of possible IA, which is a common clinical situation.

Abstract Number: M-1225

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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