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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

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Affiliated Author(s)
도영록
Alternative Author(s)
Do, Young Rok
Journal Title
Yonsei Medical Journal
ISSN
0513-5796
Issued Date
2014
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.
Key Words: Hematological malignancy, prognosis, itraconazole, empirical antifungal
therapy
Department
Dept. of Internal Medicine (내과학)
Publisher
School of Medicine
Citation
Jin Seok Kim et al. (2014). Clinical Outcomes and Prognostic Factors of Empirical Antifungal Therapy with Itraconazole in the Patients with Hematological Malignancies: A Prospective Multicenter
Observational Study in Korea. Yonsei Medical Journal, 55(1), 9–18. doi:  10.3349/ymj.2014.55.1.9
Type
Article
ISSN
0513-5796
DOI
 10.3349/ymj.2014.55.1.9
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/37242
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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