Fluconazole therapy for chronic disseminated candidiasis in patients with leukemia and prior amphotericin B therapy.
OBJECTIVE
To study the efficacy of fluconazole against chronic disseminated candidiasis (hepatosplenic candidiasis) in patients with leukemia in whom amphotericin B treatment had failed.


METHODS
Retrospective analysis of patients with chronic disseminated candidiasis treated with fluconazole on a compassionate investigational new drug protocol.


METHODS
Multi-institutional.


METHODS
Twenty consecutive patients received 100 to 400 mg of fluconazole per day for a median of 30 weeks. All had either failed to respond to treatment with more than 2 g of amphotericin B or had serious amphotericin B-related toxicities.


RESULTS
Fourteen of 16 evaluable patients (88%) responded. Responses were observed in seven of nine patients in whom adequate doses of amphotericin B had failed and in all seven patients who had amphotericin B-related toxicities. In 12 patients, cytotoxic chemotherapy was continued without flare of the infection. Fluconazole was well tolerated with rare side effects. Aspergillus superinfection developed in three patients and contributed to the death of two of them.


CONCLUSIONS
Fluconazole is a safe and effective agent with significant activity against chronic disseminated candidiasis.
Anaissie
E
E
Division of Medicine, University of Texas, M.D. Anderson Cancer Center, Houston 77030.
Bodey
G P
GP
Kantarjian
H
H
David
C
C
Barnett
K
K
Bow
E
E
Defelice
R
R
Downs
N
N
File
T
T
Karam
G
G
D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000009:adverse effects / Q000627:therapeutic use; D002177:Candidiasis / Q000188:drug therapy*; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008107:Liver Diseases / Q000188:drug therapy* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*; D012074:Remission Induction; D012189:Retrospective Studies; D013158:Splenic Diseases / Q000188:drug therapy* / Q000382:microbiology; D015163:Superinfection
D000666:Amphotericin B; D015725:Fluconazole