Posaconazole (POS) Compared to High Dose Lipid Formulations of Amphotericin B (HD-LPAMB) as Salvage Therapy for Invasive Aspergillosis (IA) in Patients (pts) with Hematologic Malignancy (HM).

I. I. RAAD1, H. HANNA 1, M. BOKTOUR 1, H. TORRES 1, C. AFIF 2, D. KONTOYIANNIS 1, R. HACHEM 1;

Author address: 

1U. T. M. D. Anderson Cancer Ctr., Houston, TX, 2Univ. of Balamand, Beirut, Lebanon.

Abstract: 

Background: When compared to conventional antifungal therapy, POS was effective as salvage treatment of IA. Several studies suggested that HD-LPAMB may also improve the outcome of salvage therapy of IA. We sought to compare POS to HD-LPAMB as salvage therapy of IA in HM. Methods: Between 1998 - 2004, 51pts with HM and definite or probable IA (according to EORTC/MSG criteria) received salvage monotherapy with POS while 49 similar pts received HD-LPAMB (≥ 7.5 mg/kg/day of either liposomal amphotericin B or ABLC monotherapy) as salvage treatment. Clinical characteristics, including age, gender, underlying malignancy, neutropenia, transplantation, ICU status, steroid or tacrolimus use, Aspergillus species, site of infection, response to salvage therapy, and safety data were retrospectively obtained. Results: Pts in the two groups had comparable risk factors such as age, underlying malignancy, BMT, duration of neutropenia, steroid and tacrolimus use and GVHD. Likewise, the Aspergillus species identified and the presence of disseminated IA were comparable in both groups. The total response to salvage therapy was 39% for POS and 8% for the HD-LPAMB group (P 8804; 0.001). When ICU pts were excluded, the 7-day response to POS (N = 35) was 49% compared to 18% of HD-LPAMB (N = 27), P = 0.03. Aspergillosis contributed to the death in 39% of patients who received POS and 63% of the HD-LPAMB group (P =0.02). By multivariate analysis, POS salvage was the only factor that improved outcome (OR 8.85; CI 95%, 2.64-29.41; P 2X increase in bilirubin or transaminasaes, P
2006

abstract No: 

M-874

Full conference title: 

46th Interscience Conference on Antimicrobial Agents and Chemotherapy
    • ICAAC 46th