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.

Soo Jeong Kim, June Won Cheong, Yoo Hong Min, Young Jin Choi, Dong Gun Lee, Je Hwan Lee, Deok Hwan Yang, Sang Min Lee, Sung Hyun Kim, Yang Soo Kim, Jae Yong Kwak, Jinny Park, Jin Young Kim, Hoon Gu Kim, Byung Soo Kim, Hun Mo Ryoo, Jun Ho Jang, Min Kyoung Kim, Hye Jin Kang, In Sung Cho & 5 others Yeung Chul Mun, Deog Yeon Jo, Ho Young Kim, Byeong Bae Park, Jin Seok Kim

Research output: Contribution to journalArticle

5 Citations (Scopus)

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).

Original languageEnglish
Pages (from-to)61-68
Number of pages8
JournalJournal of Korean Medical Science
Volume29
Issue number1
DOIs
Publication statusPublished - 2014 Jan 1

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Itraconazole
Hematologic Neoplasms
Korea
Observational Studies
Thorax
Therapeutics
Confidence Intervals
National Cancer Institute (U.S.)
Immunoenzyme Techniques
Fever
Clinical Trials
Prospective Studies

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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, Soo Jeong; Cheong, June Won; Min, Yoo Hong; Choi, Young Jin; Lee, Dong Gun; Lee, Je Hwan; Yang, Deok Hwan; Lee, Sang Min; Kim, Sung Hyun; Kim, Yang Soo; Kwak, Jae Yong; Park, Jinny; Kim, Jin Young; Kim, Hoon Gu; Kim, Byung Soo; Ryoo, Hun Mo; Jang, Jun Ho; Kim, Min Kyoung; Kang, Hye Jin; Cho, In Sung; Mun, Yeung Chul; Jo, Deog Yeon; Kim, Ho Young; Park, Byeong Bae; Kim, Jin Seok.

In: Journal of Korean Medical Science, Vol. 29, No. 1, 01.01.2014, p. 61-68.

Research output: Contribution to journalArticle

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 2014, '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.', Journal of Korean Medical Science, vol. 29, no. 1, pp. 61-68. https://doi.org/10.3346/jkms.2014.29.1.61
Kim, Soo Jeong ; Cheong, June Won ; Min, Yoo Hong ; Choi, Young Jin ; Lee, Dong Gun ; Lee, Je Hwan ; Yang, Deok Hwan ; Lee, Sang Min ; Kim, Sung Hyun ; Kim, Yang Soo ; Kwak, Jae Yong ; Park, Jinny ; Kim, Jin Young ; Kim, Hoon Gu ; Kim, Byung Soo ; Ryoo, Hun Mo ; Jang, Jun Ho ; Kim, Min Kyoung ; Kang, Hye Jin ; Cho, In Sung ; Mun, Yeung Chul ; Jo, Deog Yeon ; Kim, Ho Young ; Park, Byeong Bae ; Kim, Jin Seok. / 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. In: Journal of Korean Medical Science. 2014 ; Vol. 29, No. 1. pp. 61-68.
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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).",
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T1 - Success rate and risk factors for failure of empirical antifungal therapy with itraconazole in patients with hematological malignancies

T2 - a multicenter, prospective, open-label, observational study in Korea.

AU - Kim, Soo Jeong

AU - Cheong, June Won

AU - Min, Yoo Hong

AU - Choi, Young Jin

AU - Lee, Dong Gun

AU - Lee, Je Hwan

AU - Yang, Deok Hwan

AU - Lee, Sang Min

AU - Kim, Sung Hyun

AU - Kim, Yang Soo

AU - Kwak, Jae Yong

AU - Park, Jinny

AU - Kim, Jin Young

AU - Kim, Hoon Gu

AU - Kim, Byung Soo

AU - Ryoo, Hun Mo

AU - Jang, Jun Ho

AU - Kim, Min Kyoung

AU - Kang, Hye Jin

AU - Cho, In Sung

AU - Mun, Yeung Chul

AU - Jo, Deog Yeon

AU - Kim, Ho Young

AU - Park, Byeong Bae

AU - Kim, Jin Seok

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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).

AB - 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).

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