The majority of opportunistic fungal pathogens are represented by aspergillus and Candida species in hematological malignancies. Amphotericin B (Ampho-B) has been the goldstandard treatment during decades. In a prospective randomized trial, Voriconazole compared to Ampho-B, as initial therapy in patients with SFI, has shown an improved outcome and a better survival. Nevertheless, SFI remained a pejorative prognostic factor for survival in patients with hematological malignancies. This monocentric non randomized retrospective study concerned 95 patients [37 males, 48 females with a median age of 52 y (21-82)] harbouring an hematological malignancy, who underwent either intensive chemotherapy [first induction (1I) (n=51), induction for relapse (2I) (n=15), consolidation (n=12)] or allogeneic (n=14) or autologous transplantations (n=3). We stratified patients in 2 groups: group 1 received Ampho-B as first line therapy (n=40) before Voriconazole was commercialized in France and group 2 received Voriconazole either in first line (group 2-1: n=20) or in second or more line therapy (group 2-2: n=35) for SFI [proven, probable, possible (EORTC criterias)] or >or=2 increasing titers of aspergillus antigenemias. We performed a descriptive (Table 1) and a multivariate analysis (Table 2) using a PH cox model regression on age, sex, diagnosis, therapeutical strategy, EORTC criterias and SFI treatment. In group 1, 16 out of 40 patients died (40%) [6 from SFI (37.5%) and 10 from disease progression (DP)], in group 2-1, 6 out of 20 died (30%) [3 from SFI (50%) and 3 from DP] and in group 2-2, 18 out of 35 died (51.5%) [7 from SFI (39%) and 11 from DP]. The 6 month probability of survival was 65% (95%CI 48.5-81.4) for group 1, 65.4% (95% CI:42.6-88.3) for group 2-1 and 15.6% (95% CI:0-40) for group 2-2. The results of multivariate analysis showed the significant impact on survival of age, SFI diagnosis and SFI treatment.This retrospective study did not show any survival benefit of Voriconazole compared to Ampho-B as first line therapy for patients with hematological malignancies presenting SFI and receiving intensive chemotherapy, followed or not by autologous or allogeneic transplantations. Nevertheless, patients receiving Voriconazole presented more proven and probable SFI than patients treated by Ampho-B (75% vs 25%) but these 2 types of SFI have no significant impact in the multivariate analysis.
Full conference title:
30th Annual Meeting of the European Group for Blood and Marrow Transplantation
- EBMT 2004