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.