Clinical outcomes and prognostic factors of empirical antifungal therapy with itraconazole in the patients with hematological malignancies

A prospective multicenter observational study in Korea

Jinseok 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

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish
Pages (from-to)9-18
Number of pages10
JournalYonsei medical journal
Volume55
Issue number1
DOIs
Publication statusPublished - 2014 Jan 1

Fingerprint

Itraconazole
Hematologic Neoplasms
Korea
Multicenter Studies
Observational Studies
Mycoses
Immunocompromised Host
Fever
Therapeutics
Antifungal Agents
Tumor Burden
Lung Diseases
Multivariate Analysis
Prospective Studies
Morbidity

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Kim, Jinseok ; Cheong, June Won ; Shin, Ho Jin ; Lee, Jong Wook ; Lee, Je Hwan ; Yang, Deok Hwan ; Lee, Won Sik ; Kim, Hawk ; Park, Joon Seong ; Kim, Sung Hyun ; Kim, Yang Soo ; Kwak, Jae Yong ; Chae, Yee Soo ; Park, Jinny ; Do, Young Rok ; Min, Yoo Hong. / Clinical outcomes and prognostic factors of empirical antifungal therapy with itraconazole in the patients with hematological malignancies : A prospective multicenter observational study in Korea. In: Yonsei medical journal. 2014 ; Vol. 55, No. 1. pp. 9-18.
@article{721b7df614704ad1aa51fd7143e06d5a,
title = "Clinical outcomes and prognostic factors of empirical antifungal therapy with itraconazole in the patients with hematological malignancies: A prospective multicenter observational study in Korea",
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.",
author = "Jinseok Kim and Cheong, {June Won} and Shin, {Ho Jin} and Lee, {Jong Wook} and Lee, {Je Hwan} and Yang, {Deok Hwan} and Lee, {Won Sik} and Hawk Kim and Park, {Joon Seong} and Kim, {Sung Hyun} and Kim, {Yang Soo} and Kwak, {Jae Yong} and Chae, {Yee Soo} and Jinny Park and Do, {Young Rok} and Min, {Yoo Hong}",
year = "2014",
month = "1",
day = "1",
doi = "10.3349/ymj.2014.55.1.9",
language = "English",
volume = "55",
pages = "9--18",
journal = "Yonsei Medical Journal",
issn = "0513-5796",
publisher = "Yonsei University College of Medicine",
number = "1",

}

Kim, J, Cheong, JW, Shin, HJ, Lee, JW, Lee, JH, Yang, DH, Lee, WS, Kim, H, Park, JS, Kim, SH, Kim, YS, Kwak, JY, Chae, YS, Park, J, Do, YR & Min, YH 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, vol. 55, no. 1, pp. 9-18. https://doi.org/10.3349/ymj.2014.55.1.9

Clinical outcomes and prognostic factors of empirical antifungal therapy with itraconazole in the patients with hematological malignancies : A prospective multicenter observational study in Korea. / Kim, Jinseok; Cheong, June Won; Shin, Ho Jin; Lee, Jong Wook; Lee, Je Hwan; Yang, Deok Hwan; Lee, Won Sik; Kim, Hawk; Park, Joon Seong; Kim, Sung Hyun; Kim, Yang Soo; Kwak, Jae Yong; Chae, Yee Soo; Park, Jinny; Do, Young Rok; Min, Yoo Hong.

In: Yonsei medical journal, Vol. 55, No. 1, 01.01.2014, p. 9-18.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical outcomes and prognostic factors of empirical antifungal therapy with itraconazole in the patients with hematological malignancies

T2 - A prospective multicenter observational study in Korea

AU - Kim, Jinseok

AU - Cheong, June Won

AU - Shin, Ho Jin

AU - Lee, Jong Wook

AU - Lee, Je Hwan

AU - Yang, Deok Hwan

AU - Lee, Won Sik

AU - Kim, Hawk

AU - Park, Joon Seong

AU - Kim, Sung Hyun

AU - Kim, Yang Soo

AU - Kwak, Jae Yong

AU - Chae, Yee Soo

AU - Park, Jinny

AU - Do, Young Rok

AU - Min, Yoo Hong

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84890781074&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84890781074&partnerID=8YFLogxK

U2 - 10.3349/ymj.2014.55.1.9

DO - 10.3349/ymj.2014.55.1.9

M3 - Article

VL - 55

SP - 9

EP - 18

JO - Yonsei Medical Journal

JF - Yonsei Medical Journal

SN - 0513-5796

IS - 1

ER -