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

A Candoni1,*, S. Cesaro2, A. Busca3, D. Lazzarotto1, M. Caira4, D. Russo5, R. Fanin6, L. Pagano7

Author address: 

1Division of Hematology and HSCT, University of Udine and AOUD, Udine, 2Pediatric Hematology Oncology, Verona, 3Department of Hematology, San Giovanni Battista Hospital, Torino, 4Institute of Hematology, Università Cattolica del Sacro Cuore, Rome, 5Unit of Blood Diseases and Stem Cell Transplantation, University of Brescia, Brescia, 6University of Udine and AOUD, Udine, 7Università Cattolica del Sacro Cuore, Rome, Italy

Abstract: 

Introduction:  The  Combination  (Combo)  antifungal  therapy  is  a  very  hot  topic  in  haematology.  This  multicentre  observational  study  reported  the  effi    cacy  and  toxicity,  in  clinical  practice,  of  antifungal  Combo  therapy    as  treatment  of  proven  or  probable  Invasive Mold Diseases (IMDs) in Hematopoietic Stem Cell Trans-plantation (HSCT) recipients.Materials (or patients) 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 hemato-logic disease (17/30; 57%); 10/30 (33%) of cases were in complete remission  and  20/30  (67%)  had  refractory  or  relapsed  hemato-logic 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 amphoter-icin 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 respond-ers) without signifi cant diff  erences between the Combo regimens. The  granulocyte  (PMN)  recovery  did  not  signifi cantly infl uenced the   response   to   the   Combo   therapy   in   HSCT   recipients.   Only   29%  of  patients  experienced  mild  and  reversible  adverse  events  (hypokalemia, ALT/AST increase, creatinine increase). The mortal-ity IFD related was low (24%).Discussion:   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%.

2014

abstract No: 

PH-P464

Full conference title: 

Annual Meeting of European Society for Blood and Marrow Transplantation
    • EBMT 40th (2014)