Clinical Outcomes and Prognostic Factors of Empirical Antifungal Therapy with Itraconazole in the Patients with Hematological Malignancies: A Prospective Multicenter Observational Study in Korea

被引:1
|
作者
Kim, Jin Seok [1 ]
Cheong, June-Won [1 ]
Shin, Ho Jin [2 ]
Lee, Jong Wook [3 ]
Lee, Je-Hwan [4 ]
Yang, Deok-Hwan [5 ]
Lee, Won Sik [6 ]
Kim, Hawk [7 ]
Park, Joon Seong [8 ]
Kim, Sung-Hyun [9 ]
Kim, Yang Soo [10 ]
Kwak, Jae-Yong [11 ]
Chae, Yee Soo [12 ]
Park, Jinny [13 ]
Do, Young Rok [14 ]
Min, Yoo Hong [1 ]
机构
[1] Yonsei Univ, Severance Hosp, Coll Med, Dept Internal Med,Div Hematol, Seoul 120752, South Korea
[2] Pusan Natl Univ, Pusan Natl Univ Hosp, Sch Med, Dept Hematol Oncol, Pusan, South Korea
[3] Catholic Univ Korea, Seoul St Marys Hosp, Dept Internal Med, Seoul, South Korea
[4] Univ Ulsan, Coll Med, Asan Med Ctr, Dept Hematol, Seoul, South Korea
[5] Chonnam Natl Univ, Hwasun Hosp, Dept Hematol Oncol, Hwasun, South Korea
[6] Inje Univ, Busan Paik Hosp, Dept Internal Med, Pusan, South Korea
[7] Univ Ulsan, Ulsan Univ Hosp, Coll Med, Dept Internal Med, Ulsan 680749, South Korea
[8] Ajou Univ, Sch Med, Dept Hematol Oncol, Suwon 441749, South Korea
[9] Dong A Univ, Coll Med, Dept Internal Med, Pusan, South Korea
[10] Kosin Univ, Gospel Hosp, Dept Internal Med, Pusan, South Korea
[11] Chonbuk Natl Univ, Sch Med, Dept Internal Med, Jeonju, South Korea
[12] Kyungpook Natl Univ Hosp, Dept Hematol Oncol, Taegu, South Korea
[13] Gachon Univ, Gil Med Ctr, Dept Internal Med, Inchon, South Korea
[14] Keimyung Univ, Dongsan Med Ctr, Sch Med, Dept Internal Med, Taegu, South Korea
关键词
Hematological malignancy; prognosis; itraconazole; empirical antifungal therapy; LIPOSOMAL AMPHOTERICIN-B; CELL TRANSPLANTATION RECIPIENTS; INFECTIOUS-DISEASES SOCIETY; INVASIVE FUNGAL-INFECTIONS; NEUTROPENIC PATIENTS; PERSISTENT FEVER; ASPERGILLOSIS; GUIDELINES; CANCER; DEOXYCHOLATE;
D O I
10.3349/ymj.2014.55.1.9
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Purpose: To identify prognostic factors for the outcomes of empirical antifungal therapy, we performed a multicenter, prospective, observational study in immunocompromised patients with hematological malignancies. Materials and Methods: Three hundred seventy-six patients (median age of 48) who had neutropenic fever and who received intravenous (IV) itraconazole as an empirical antifungal therapy for 3 or more days were analyzed. The patients with possible or probable categories of invasive fungal disease (IFD) were enrolled. Results: The overall success rate was 51.3% (196/376). Age >50 years, underlying lung disease (co-morbidity), poor performance status [Eastern Cooperative Oncology Group (ECOG) >= 2], radiologic evidence of IFD, longer duration of baseline neutropenic fever (>= 4 days), no antifungal prophylaxis or prophylactic use of antifungal agents other than itraconazole, and high tumor burden were associated with decreased success rate in univariate analysis. In multivariate analysis, age >50 years (p=0.009) and poor ECOG performance status (p=0.005) were significantly associated with poor outcomes of empirical antifungal therapy. Twenty-two patients (5.9%) discontinued itraconazole therapy due to toxicity. Conclusion: We concluded that empirical antifungal therapy with W itraconazole in immunocompromised patients is effective and safe. Additionally, age over 50 years and poor performance status were poor prognostic factors for the outcomes of empirical antifungal therapy with IV itraconazole.
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页码:9 / 18
页数:10
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