Efficacy of caspofungin and itraconazole as secondary antifungal prophylaxis: analysis of data from a multinational case registry
Por:
Vehreschild, JJ, Sieniawski, M, Reuter, S, Arenz, D, Reichert, D, Maertens, J, Bohme, A, Silling, G, Martino, R, Maschmeyer, G, Rueping, MJGT, Ullmann, AJ, Cornely, OA
Publicada:
1 nov 2009
Resumen:
Patients surviving invasive fungal disease (IFD) and needing further antineoplastic chemotherapy are at high risk of recurrent fungal infection. In the absence of randomised controlled trials in this area, secondary prophylactic regimens are diverse. From 448 patients registered with the Multinational Case Registry of Secondary Antifungal Prophylaxis, we performed an analysis of patients receiving caspofungin (CAS) or itraconazole (ITC). All patients had an underlying haematological malignancy and had been diagnosed with an episode of IFD earlier in their course of treatment. Data collected comprised demographics, underlying disease, first episode of IFD, antifungal prophylaxis, incidence and outcome of breakthrough IFD and survival. A total of 75 patients were evaluated, comprising 28 receiving CAS and 47 receiving ITC. Patients in the CAS group were more likely to have had progression of underlying disease (32.1% vs. 8.5%; P = 0.028) as well as incomplete response of initial IFD at baseline (85.7% vs. 57.4%; P = 0.005). Allogeneic stem cell transplantation was more prevalent in patients receiving CAS (46.4% vs. 14.9%; P = 0.010). There was no difference in the occurrence of breakthrough IFD between both groups (32.1% vs. 31.9%). Treatment outcomes for recurrent IFD and overall mortality did not differ between groups. Both ITC and CAS were equally effective in preventing second episodes of IFD. Patients with uncontrolled first IFD, uncontrolled underlying disease or those receiving stem cell transplantation were more likely to have received CAS prophylaxis. Despite antifungal prophylaxis, risk of breakthrough IFD was high in both groups. (C) 2009 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.
Filiaciones:
Vehreschild, JJ:
Klinikum Univ Koln, Innere Med Klin 1, D-50937 Cologne, Germany
Sieniawski, M:
Klinikum Univ Koln, Innere Med Klin 1, D-50937 Cologne, Germany
Reuter, S:
Univ Klinikum Dusseldorf, Klin Gastroenterol Hepatol & Infektiol, Dusseldorf, Germany
Arenz, D:
Klinikum Univ Koln, Innere Med Klin 1, D-50937 Cologne, Germany
Klinikum Univ Koln, ZKS Koln, BMBF 01KN0706, D-50937 Cologne, Germany
Reichert, D:
Hamatol Onkol Gemeinschaftspraxis Dr Reichert Dr, Westerstede, Germany
Maertens, J:
Univ Hosp Gasthuisberg, Dept Hematol, B-3000 Leuven, Belgium
Bohme, A:
Onkologikum Frankfurt Museumsufer, Frankfurt, Germany
Silling, G:
Univ Klinikum Munster, Med Klin A, Munster, Germany
Martino, R:
Hosp Santa Crue & Santa Pau Barcelona, Div Clin Hematol, Barcelona, Spain
Maschmeyer, G:
Klinikum Ernst Von Bergmann, Klin Hamatol & Onkol, Potsdam, Germany
Rueping, MJGT:
Klinikum Univ Koln, Innere Med Klin 1, D-50937 Cologne, Germany
Ullmann, AJ:
Johannes Gutenberg Univ Mainz, Dept Med 3, Mainz, Germany
Cornely, OA:
Klinikum Univ Koln, Innere Med Klin 1, D-50937 Cologne, Germany
Klinikum Univ Koln, ZKS Koln, BMBF 01KN0706, D-50937 Cologne, Germany
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