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J Korean Med Sci. 2014 Jan;29(1):61-8. doi: 10.3346/jkms.2014.29.1.61. Epub 2013 Dec 26.

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.

Author information

1
Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea.
2
Department of Hematology/Oncology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
3
Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
4
Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
5
Department of Hematology/Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
6
Department of Internal Medicine, Busan Paik Hospital, Inje University, Busan, Korea.
7
Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.
8
Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea.
9
Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.
10
Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
11
Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
12
Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.
13
Department of Internal Medicine, Korea University Medical Center, Seoul, Korea.
14
Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea.
15
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
16
Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
17
Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
18
Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea.
19
Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
20
Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
21
Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
22
Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.

Abstract

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).

KEYWORDS:

Empirical Antifungal Therapy; Galactomannan Test; Hematological Malignancy; Itraconazole

PMID:
24431907
PMCID:
PMC3890478
DOI:
10.3346/jkms.2014.29.1.61
[Indexed for MEDLINE]
Free PMC Article

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