Introduction: The Combination (Combo) antifungal therapy is a very hot topic in haematology. This multicentre observational study reported the efficacy and toxicity, in clinical practice, of antifungal Combo therapy as treatment of proven or probable Invasive Mold Diseases (IMDs) in Hematopoietic Stem Cell Transplantation (HSCT) recipients. Materials (or patients) and methods: Between June 2006 and June 2012, 30 cases of IMDs (16 proven and 14 probable) treated with Combo were reported from 7 HSCT Centers in Italy. Median age of HSCT patients was 29 yrs (range 2-61) and 26% had less than 18 yrs. Acute Leukemia was their most common underlying hematologic disease (17/30; 57%); 10/30 (33%) of cases were in complete remission and 20/30 (67%) had refractory or relapsed hematologic disease. The main site of infection was lung with or without other sites. The causative moulds were: Aspergillus sp in 22 cases (74%), Zygomycetes in 4 cases (13%), Fusarium sp in 3 cases (10%) and Paecilomyces sp in 1/30 (3%). Results: The most used Combo therapy were caspofungin+voriconazole (13/30 pts-43%), caspofungin+liposomal amphotericin B (L-AmB) (7/30 pts-22%), and L-AmB+voriconazole (8/30 pts-26%). The median duration of Combo therapy was 30 days (range 7-154). The overall response rate (ORR) was 67% (20/30 responders) without significant differences between the Combo regimens. The granulocyte (PMN) recovery did not significantly influenced the response to the Combo therapy in HSCT recipients. Only 29% of patients experienced mild and reversible adverse events (hypokalemia, ALT/AST increase, creatinine increase). The mortality IFD related was low (24%). Discussion: This observational study indicates that Combo therapy was well tolerated and effective in HSCT with proven or probable IMDs. The most used Combo regimens in clinical practice were caspofungin+voriconazole (with a response rate of 80%) and caspofungin+ L-AmB (response rate 70%). The ORR was 67%.
Efficacy and toxicity in clinical practice of antifungal combination therapy for proven or probable invasive mold diseases in hematopoietic stem cell transplantation.
CESARO, SIMONE;
2014-01-01
Abstract
Introduction: The Combination (Combo) antifungal therapy is a very hot topic in haematology. This multicentre observational study reported the efficacy and toxicity, in clinical practice, of antifungal Combo therapy as treatment of proven or probable Invasive Mold Diseases (IMDs) in Hematopoietic Stem Cell Transplantation (HSCT) recipients. Materials (or patients) and methods: Between June 2006 and June 2012, 30 cases of IMDs (16 proven and 14 probable) treated with Combo were reported from 7 HSCT Centers in Italy. Median age of HSCT patients was 29 yrs (range 2-61) and 26% had less than 18 yrs. Acute Leukemia was their most common underlying hematologic disease (17/30; 57%); 10/30 (33%) of cases were in complete remission and 20/30 (67%) had refractory or relapsed hematologic disease. The main site of infection was lung with or without other sites. The causative moulds were: Aspergillus sp in 22 cases (74%), Zygomycetes in 4 cases (13%), Fusarium sp in 3 cases (10%) and Paecilomyces sp in 1/30 (3%). Results: The most used Combo therapy were caspofungin+voriconazole (13/30 pts-43%), caspofungin+liposomal amphotericin B (L-AmB) (7/30 pts-22%), and L-AmB+voriconazole (8/30 pts-26%). The median duration of Combo therapy was 30 days (range 7-154). The overall response rate (ORR) was 67% (20/30 responders) without significant differences between the Combo regimens. The granulocyte (PMN) recovery did not significantly influenced the response to the Combo therapy in HSCT recipients. Only 29% of patients experienced mild and reversible adverse events (hypokalemia, ALT/AST increase, creatinine increase). The mortality IFD related was low (24%). Discussion: This observational study indicates that Combo therapy was well tolerated and effective in HSCT with proven or probable IMDs. The most used Combo regimens in clinical practice were caspofungin+voriconazole (with a response rate of 80%) and caspofungin+ L-AmB (response rate 70%). The ORR was 67%.
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