THIEBAUT A, ANTAL D, BREYSSE MC, PIVOT C; Interscience Conference on Antimicrobial Agents and Chemotherapy (42nd : 2002 : San Diego, Calif.).
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2002 Sep 27-30; 42: abstract no. M-859.
E. Herriot Hospital, Lyon, France
BACKGROUND: Invasive fungal infections commonly represent complications in pts with hematologic malignancies. Prolonged and severe neutropenia is the most important risk factor. The mortality remains high and amphotericinB is the mainstay antifungal treatment. However, results remains unsatisfactory. Two new antifungal agents are now available and synergic action has already been described in vitro. METHODS: A retrospective study of pts who received combination of caspofungin and amphotericinB or voriconazole and amphoterinB for progressive invasive fungal infections. RESULTS: Between june 2001 and april 2002,14 pts received a combination of antifungal agents: caspofungin and amphotericinB (n = 9), voriconazole and amphotericinB (n = 4), voriconazole and amphotericinB and caspofungin in one pt. Hemopathies were an acute myeloid leukemia (n = 12), acute lymphoid leukemia (n = 1) and multiple myeloma (n = 1). Aspergillosis was certain in 4 cases, probable in 7 cases and possible in 2 cases with EORTC criteria. One pt presented a Candida septicemia. All pts received a first line therapy with amphotericinB and we oberved a progression. The median duration of amphotericinB therapy was 13,5 days (range 2-21) prior to adding caspofungin or voriconazole. Five pts received combination therapy before 10 days of amphotericinB monotherapy because of early rapid clinical progression or because of cerebral aspergillosis (n = 1). Overall 5 pts have a favorable response (35.7%), one stable disease. Nine pts died. All of these pts presented a progressive hematologic disease or a prolonged neutropenia. We did not observed any severe toxicity. Conclusion: Combinaton of antifungal agents are safety and can be effective in pt with hematologic malignancies in complete remission. However, clinical trials are waranted to define new therapeutic strategy in invasive fungal infections.
Publication Types:
Keywords:
- Antifungal Agents
- Aspergillosis
- Candidiasis
- Hematologic Neoplasms
- Humans
- In Vitro
- Miconazole
- Mycoses
- Neutropenia
- Peptides, Cyclic
- Pyrimidines
- Retrospective Studies
- Triazoles
- caspofungin
- voriconazole
Other ID:
UI: 102266744
From Meeting Abstracts