title: A clinical cohort trial of antifungal combination therapy: efficacy and toxicity in haematological cancer patients.
abstract: Invasive fungal infections (IFI) are a major cause of morbidity and mortality in patients with haematological malignancies. Antifungal combination therapy is a promising treatment option. However, available data on feasibility, toxicity and efficacy of this therapy are limited. Therefore, this study was conducted to evaluate the feasibility, toxicity and outcome of different antifungal combination therapies. Patients with haematological malignancies receiving antifungal combination therapy for IFI were retrospectively analysed. Toxicity and response were documented at the end of therapy. Survival was evaluated at the end of therapy and after 12 weeks. Fifty-six patients were treated with different antifungal combinations in the period between 2001 and 2007. The majority of patients (63%) received a combination of liposomal amphotericin B and caspofungin as antifungal combination treatment. Toxicity of all applied combinations was tolerable. At the end of combination therapy, favourable response was 65%, whereas unfavourable outcome occurred in 35% of the cases. Mortality at the end of treatment was 11% and 34% 3 months after initiation of combination therapy. Antifungal combination therapy is feasible and efficient in haematological cancer patients and allogeneic stem cell transplant recipients with IFI. Prospective studies to evaluate the optimal combinations are needed.
authors.affiliation: Department of Haematology/Oncology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377 Munich, Germany. christina.rieger@med.uni-muenchen.de
authors.forename: Christina T
authors.initials: CT
authors.lastname: Rieger
authors.forename: Helmut
authors.initials: H
authors.lastname: Ostermann
authors.forename: Hans-Jochem
authors.initials: HJ
authors.lastname: Kolb
authors.forename: Michael
authors.initials: M
authors.lastname: Fiegl
authors.forename: Saskia
authors.initials: S
authors.lastname: Huppmann
authors.forename: Nicole
authors.initials: N
authors.lastname: Morgenstern
authors.forename: Johanna
authors.initials: J
authors.lastname: Tischer
mesh_terms: D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000009:adverse effects*; D000935:Antifungal Agents / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects; D000077336:Caspofungin; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D054714:Echinocandins / Q000009:adverse effects*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007938:Leukemia / Q000150:complications* / Q000628:therapy; D055666:Lipopeptides; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000517:prevention & control*; D019653:Myeloablative Agonists / Q000009:adverse effects; D009190:Myelodysplastic Syndromes / Q000150:complications* / Q000628:therapy; D012189:Retrospective Studies; D016019:Survival Analysis; D014184:Transplantation, Homologous / Q000009:adverse effects
chemical_list: D000935:Antifungal Agents; D000970:Antineoplastic Agents; D054714:Echinocandins; D055666:Lipopeptides; D019653:Myeloablative Agonists; C068538:liposomal amphotericin B; D000666:Amphotericin B; D000077336:Caspofungin