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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, Vol.29(1) : 61-68, 2014 
Journal Title
Issue Date
14-alpha Demethylase Inhibitors/adverse effects ; 14-alpha Demethylase Inhibitors/therapeutic use ; Adolescent ; Adult ; Aged ; Antifungal Agents/adverse effects ; Antifungal Agents/therapeutic use* ; Aspergillosis/complications ; Aspergillosis/drug therapy* ; Candidiasis/complications ; Candidiasis/drug therapy* ; Coccidioidomycosis/complications ; Coccidioidomycosis/drug therapy ; Febrile Neutropenia/complications ; Febrile Neutropenia/drug therapy ; Female ; Hematologic Neoplasms/complications ; Hematologic Neoplasms/drug therapy ; Hematologic Neoplasms/microbiology* ; Humans ; Itraconazole/adverse effects ; Itraconazole/therapeutic use* ; Male ; Mannans/blood ; Middle Aged ; Prospective Studies ; Treatment Outcome ; Young Adult
Empirical Antifungal Therapy ; Galactomannan Test ; Hematological Malignancy ; Itraconazole
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)
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Soo Jeong(김수정) ORCID logo https://orcid.org/0000-0001-8859-3573
Kim, Jin Seok(김진석) ORCID logo https://orcid.org/0000-0001-8986-8436
Min, Yoo Hong(민유홍) ORCID logo https://orcid.org/0000-0001-8542-9583
Cheong, June-Won(정준원) ORCID logo https://orcid.org/0000-0002-1744-0921
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