J Korean Med Sci.  2014 Jan;29(1):61-68. 10.3346/jkms.2014.29.1.61.

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

• Kim SJ
• Cheong JW
• Min YH
• Choi YJ
• Lee DG
• Lee JH
• Yang DH
• Lee SM
• Kim SH
• Kim YS
• Kwak JY
• Park J
• Kim JY
• Kim HG
• Kim BS
• Ryoo HM
• Jang JH
• Kim MK
• Kang HJ
• Cho IS
• Mun YC
• Jo DY
• Kim HY
• Park BB
• Kim JS

• KMID: 1796916
• DOI: http://doi.org/10.3346/jkms.2014.29.1.61

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)

Keyword

Hematological Malignancy; Itraconazole; Empirical Antifungal Therapy; Galactomannan Test

MeSH Terms

14-alpha Demethylase Inhibitors/adverse effects/therapeutic use
Adolescent
Adult
Aged
Antifungal Agents/adverse effects/*therapeutic use
Aspergillosis/complications/*drug therapy
Candidiasis/complications/*drug therapy
Coccidioidomycosis/complications/drug therapy
Febrile Neutropenia/complications/drug therapy
Female
Hematologic Neoplasms/complications/drug therapy/*microbiology
Humans
Itraconazole/adverse effects/*therapeutic use
Male
Mannans/blood
Middle Aged
Prospective Studies
Treatment Outcome
Young Adult
14-alpha Demethylase Inhibitors
Antifungal Agents
Mannans
Itraconazole

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