Efficacy and Safety Profile of Caspofungin as a Salvage Therapy for Invasive Fungal Infections in Korean Patients with Hematologic Diseases.
- Author:
Su Mi CHOI
1
;
Sun Hee PARK
;
Dong Gun LEE
;
Jung Hyun CHOI
;
Jin Hong YOO
;
Woo Sung MIN
;
Wan Shik SHIN
;
Chun Choo KIM
Author Information
1. Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. fire@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Invasive Fungal Infection;
Caspofungin;
Salvage Therapy
- MeSH:
Adult;
Amphotericin B;
Antifungal Agents;
Drug Therapy;
Female;
Fever;
Hematologic Diseases*;
Hematologic Neoplasms;
Hematopoietic Stem Cell Transplantation;
Humans;
Itraconazole;
Leukemia;
Leukemia, Myelogenous, Chronic, BCR-ABL Positive;
Male;
Mortality;
Myelodysplastic Syndromes;
Prognosis;
Salvage Therapy*;
Skin
- From:
Infection and Chemotherapy
2005;37(5):247-254
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Invasive fungal infection (IFI) is an important cause of morbidity and mortality in patients with hematologic malignancy. Patients with IFI who fail to standard therapy have poor prognoses. We investigated the efficacy and safety of caspofungin (CAS) in Korean adults with hematologic diseases and IFI who did not respond to the conventional antifungal therapy. MATERIALS AND METHODS: Patients with IFI refractory or intolerant to standard antifungal therapy received CAS 50 mg IV daily after 70 mg loading dose on day 1. Efficacy and safety of CAS were assessed in patients who received more than one dose. Favorable response [complete (CR) or partial (PR)] was defined as significant improvement of all clinical symptoms, signs, and radiologic abnormalities. RESULTS: From Feb. 2004 to Feb. 2005, 55 patients who met the inclusion criteria were enrolled. There were 32 male and 23 female patients with mean age of 38.2 years (range, 16-65). Underlying diseases were acute leukemia (33 cases), myelodysplastic syndrome (12 cases), chronic myelogenous leukemia (3 cases), and other hematologic diseases (7 cases). Thirty-six patients were receiving chemotherapy and 13 patients were under hematopoietic stem cell transplantation (HSCT). The number of proven, probable, possible, and indeterminate IFI cases was 1, 5, 47, and 2, respectively. Conventional amphotericin B, intravenous itraconazole, and liposomal amphotericin B were administered for average of 14.9 days prior to administering CAS. Mean duration of CAS therapy was 12.8 days (range, 1-45). Twenty-three patients (41.8%) showed favorable responses (CR:PR=8:15) at the end of CAS therapy. Chemotherapy group, neutropenic state, remitted state of underlying disease, and no steroid therapy were significant prognostic factors for favorable response. Eight (14.5%) patients developed drug-related adverse events such as fever, skin eruption, and hepatic dysfunction which were reversible after discontinuation of CAS. Drug-related nephrotoxicity was not observed. CONCLUSION: On the basis of our investigation, CAS was effective and safe as a salvage therapy of refractory IFI or as an alternative for patients intolerant to standard antifungal agents.
