EFFICACY AND TOXICITY IN CLINICAL PRACTICE OF ANTIFUNGAL COMBINATION THERAPY FOR PROVEN or PROBABLE INVASIVE MOLD DISEASES IN HEMATOPOIETIC STEM CELL TRANSPLANTATION

Ref ID: 19546

Author:

A Candoni1,2*, S Cesaro2, M Caira3,2, A Busca2, M Giacchino2, D Lazzarotto1, D Russo2,
AM Nosari2, L Pagano3,2

Author address:

1Division of Hematology and BMT, University of Udine, Udine, Italy
2SEIFEM Group – Sorveglianza Epidemiologica Infezioni Fungine nelle Emopatie, Italy
3Division of Hematology, UCSC, Roma, Italy

Full conference title:

6th Advances Against Aspergillosis 2014

Abstract:

Introduction:
This multicentre observational study reported efficacy and toxicity of antifungal combination
(Combo) therapy as treatment of proven or probable invasive mold diseases (IMDs) in hematopoietic
stem cell transplantation (HSCT) recipients.
Materials and Methods:
Between June 2006 and June 2012, 30 cases of IMDs (16 proven and 14 probable) treated with
Combo were reported from 7 HSCT Centers in Italy. Median age of HSCT patients was 29 yrs
(range 2-61) and 26% had less than 18 yrs. Acute leukemia was their most common underlying
hematologic disease (17/30; 57%); 10/30 (33%) of cases were in complete remission and 20/30
(67%) had refractory or relapsed hematologic disease. The main site of infection was lung with or
without other sites. The causative moulds were: Aspergillus sp in 22 cases (74%), Zygomycetes in
4 cases (13%), Fusarium sp in 3 cases (10%) and Paecilomyces sp in 1/30 (3%).
Results:
The most used combo therapy were caspofungin+voriconazole (13/30 pts-43%), caspofungin +
liposomal amphotericin B (L-AmB) (7/30 pts-22%), and L-AmB+voriconazole (8/30 pts-26%). The
median duration of combo therapy was 30 days (range 7-154). The overall response rate (ORR)
was 67% (20/30 responders) without significant differences between the combo regimens. The
granulocyte (PMN) recovery did not significantly influenced the response to combo therapy in HSCT
recipients. Only 29% of patients experienced mild and reversible adverse events (hypokalemia,
ALT/AST increase, creatinine increase). The mortality IFD related was 24%.
Conclusion:
This observational study indicates that combo therapy was well tolerated and effective in
HSCT with proven or probable IMDs. The most used combo regimens in clinical practice were
caspofungin+voriconazole (with a response rate of 80%) and caspofungin+ L-AmB (response rate
70%). The ORR was 67%.

Abstract Number: 73

Conference Year: 2014

Link to conference website: http://www.AAA2014.org

New link: NULL

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