STATISTICAL CORRELATIONS BETWEEN QUANTIFIABLE DISEASE VARIABLES AND PROGNOSIS IN HAEMATOLOGICAL MALIGNANCY PATIENTS TREATED WITH ITRACONAZOLE AS AN EMPIRICAL ANTIFUNGAL THERAPY: A PROSPECTIVE MULTICENTER OBSERVATIONAL STUDY IN KOREA

J. Kim1*, H. Shin2, J. Lee3, K. Lee4, D. Yang5, W. Lee6, H. Kim7, S. Sohn8, J. Park9, S. Kim10

Author address: 

1Yonsei University College of Medicine 2Pusan National University Medical School 3St. Mary’s Hospital, College of Medicine 4Asan Medical Center, University of Ulsan College of Medicine 5Chonnam National University Hwasun Hospital 6Busan Paik Hos

Abstract: 

Purpose: We identified the clinical characteristics including disease status for expecting success outcome of empirical antifungal therapy for invasive fungal infection (IFI) using itraconazole in immunocompromised patients with haematological malignancies. Methods: The prospective multicenter observational study was performed at 26 medical centers for 9 months. Results: 376 patients (median age 48) were enrolled and analyzed. The patients with possible and probable categories for IFI according to the EORTC/MSG criteria were included. We excluded the patients with proven IFI. IV itraconazole was administered as routine schedule, followed by oral itraconazole solution. Underlying disease consisted of 61% of AML and 15% of ALL. Overall success rate of empirical antifungal therapy with itraconazole was 196/376 (51%). Acute leukemia in non-CR status and advanced stage of MDS patients showed a lower trend of success rate. Combined co-morbidities, underlying lung disease, poor ECOG performance status (≥ 2), abnormal chest X-ray at the time of initiation of empirical antifungal therapy, no early initiation of empirical antifungal therapy (the duration of baseline neutropenic fever ≥ 3 days) and antifungal prophylaxis other than itraconazole were associated with decreased overall success rate. Multivariate analysis revealed that poor performance status (≥ 2) (HR=1.9) and abnormal chest X-ray (HR=2.0) were significantly associated with poor outcome of empirical antifungal therapy. Overall success rate of empirical antifungal therapy was not affected by antifungal prophylaxis. Defervescence in setting of neutropenia was 70% (264/276). Higher rate of defervescence was observed in the patients with early stage of MDS (92% vs. 40%, P = 0.02). Median time to defervescence after empirical itraconazole therapy was 3 days. Short mean time to defervescence was observed in the patients with acute leukemia in CR status (P = 0.002) or early stage of lymphoid malignancies (P = 0.03). The rate of breakthrough fungal infection was 4% (16/376). Breakthrough Aspergillus infection was documented in the half of theses patients (8/16). Conclusions: IV itraconazole followed by oral itraconazole solution is an effective regimen for empirical antifungal therapy. Poor performance status and abnormal chest X-ray were predictive factors for failure of empirical antifungal therapy.
2010

abstract No: 

74

Full conference title: 

4th Advances Against Aspergillosis
    • AAA 4th (2010)