1.Success Rate and Risk Factors for Failure of Empirical Antifungal Therapy with Itraconazole in Patients with Hematological Malignancies: A Multicenter, Prospective, Open-Label, Observational Study in Korea.
Soo Jeong KIM ; June Won CHEONG ; Yoo Hong MIN ; Young Jin CHOI ; Dong Gun LEE ; Je Hwan LEE ; Deok Hwan YANG ; Sang Min LEE ; Sung Hyun KIM ; Yang Soo KIM ; Jae Yong KWAK ; Jinny PARK ; Jin Young KIM ; Hoon Gu KIM ; Byung Soo KIM ; Hun Mo RYOO ; Jun Ho JANG ; Min Kyoung KIM ; Hye Jin KANG ; In Sung CHO ; Yeung Chul MUN ; Deog Yeon JO ; Ho Young KIM ; Byeong Bae PARK ; Jin Seok KIM
Journal of Korean Medical Science 2014;29(1):61-68
We assessed the success rate of empirical antifungal therapy with itraconazole and evaluated risk factors for predicting the failure of empirical antifungal therapy. A multicenter, prospective, observational study was performed in patients with hematological malignancies who had neutropenic fever and received empirical antifungal therapy with itraconazole at 22 centers. A total of 391 patients who had abnormal findings on chest imaging tests (31.0%) or a positive result of enzyme immunoassay for serum galactomannan (17.6%) showed a 56.5% overall success rate. Positive galactomannan tests before the initiation of the empirical antifungal therapy (P=0.026, hazard ratio [HR], 2.28; 95% confidence interval [CI], 1.10-4.69) and abnormal findings on the chest imaging tests before initiation of the empirical antifungal therapy (P=0.022, HR, 2.03; 95% CI, 1.11-3.71) were significantly associated with poor outcomes for the empirical antifungal therapy. Eight patients (2.0%) had premature discontinuation of itraconazole therapy due to toxicity. It is suggested that positive galactomannan tests and abnormal findings on the chest imaging tests at the time of initiation of the empirical antifungal therapy are risk factors for predicting the failure of the empirical antifungal therapy with itraconazole. (Clinical Trial Registration on National Cancer Institute website, NCT01060462)
14-alpha Demethylase Inhibitors/adverse effects/therapeutic use
;
Adolescent
;
Adult
;
Aged
;
Antifungal Agents/adverse effects/*therapeutic use
;
Aspergillosis/complications/*drug therapy
;
Candidiasis/complications/*drug therapy
;
Coccidioidomycosis/complications/drug therapy
;
Febrile Neutropenia/complications/drug therapy
;
Female
;
Hematologic Neoplasms/complications/drug therapy/*microbiology
;
Humans
;
Itraconazole/adverse effects/*therapeutic use
;
Male
;
Mannans/blood
;
Middle Aged
;
Prospective Studies
;
Treatment Outcome
;
Young Adult
Result Analysis
Print
Save
E-mail