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

Authors
 Jin Seok Kim  ;  June-Won Cheong  ;  Ho Jin Shin  ;  Jong Wook Lee  ;  Je-Hwan Lee  ;  Deok-Hwan Yang  ;  Won Sik Lee  ;  Hawk Kim  ;  Joon Seong Park  ;  Sung-Hyun Kim  ;  Yang Soo Kim  ;  Jae-Yong Kwak  ;  Yee Soo Chae  ;  Jinny Park  ;  Young Rok Do  ;  Yoo Hong Min 
Citation
 Yonsei Medical Journal, Vol.55(1) : 9-18, 2014 
Journal Title
 Yonsei Medical Journal 
ISSN
 0513-5796 
Issue Date
2014
MeSH
Antifungal Agents/adverse effects ; Antifungal Agents/therapeutic use* ; Female ; Hematologic Neoplasms ; Humans ; Immunocompromised Host ; Itraconazole/adverse effects ; Itraconazole/therapeutic use* ; Male ; Middle Aged ; Prospective Studies ; Republic of Korea
Keywords
Hematological malignancy ; empirical antifungal therapy ; itraconazole ; prognosis
Abstract
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 IV 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.
Files in This Item:
T201400186.pdf Download
DOI
10.3349/ymj.2014.55.1.9
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
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
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/98023
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