Clinical outcomes and prognostic factors of empirical antifungal therapy with itraconazole in the patients with hematological malignancies: A prospective multicenter observational study in Korea

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

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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

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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    Kim, J. S., Cheong, J. W., Shin, H. J., Lee, J. W., Lee, J. H., Yang, D. H., Lee, W. S., Kim, H., Park, J. S., Kim, S. H., Kim, Y. S., Kwak, J. Y., Chae, Y. S., Park, J., Do, Y. R., & Min, Y. H. (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. https://doi.org/10.3349/ymj.2014.55.1.9