title: Early implementation of antifungal therapy in the management of febrile neutropenia is associated with favourable outcome during induction chemotherapy for acute leukaemias.
abstract: BACKGROUND
  Mortality related to induction chemotherapy during the treatment of acute leukaemias (AL) has been estimated at 5-20%, and this increases with age. Fungal infection remains one of the major causes of morbidity and mortality and is considered an obstacle to the successful management of acute leukaemias.
  
  
  METHODS
  We retrospectively analysed all patients treated for acute leukaemias at a single institution between July 2006 and January 2009, to assess the impact of early antifungal therapy on outcome during induction chemotherapy. There were 44 episodes of induction chemotherapy, with a median age of patients of 61 years (range 18-81), including 29 patients with acute myeloid leukaemia, 9 with acute lymphoblastic leukaemia and 6 with relapsed AL. The median age was 61 years (range 18-81), and 20 patients were over the age of 60 years.
  
  
  RESULTS
  All patients who developed febrile neutropenia received broad-spectrum antibiotics. Early empirical antifungal treatment was commenced with voriconazole (15 patients) or caspofungin (12 patients) if the febrile neutropenia did not resolve after 72 h of antibiotic therapy, in conjunction with radiological changes consistent with possible fungal infection. None of the patients succumbed during induction chemotherapy. The 120-day mortality rate after the induction therapy was 2.2%, without any incidence of invasive fungal disease.
  
  
  CONCLUSIONS
  Our analysis shows that early empirical treatment for fungal infection with voriconazole or caspofungin is associated with a favourable outcome of induction therapy for acute leukaemias. Further studies to confirm this finding are warranted.
authors.affiliation: Department of Haematology, Launceston General Hospital, Australia. khalafallah@dhhs.tas.gov.au
authors.forename: A
authors.initials: A
authors.lastname: Khalafallah
authors.forename: M
authors.initials: M
authors.lastname: Maiwald
authors.forename: T
authors.initials: T
authors.lastname: Hannan
authors.forename: S
authors.initials: S
authors.lastname: Abell
authors.forename: J
authors.initials: J
authors.lastname: Staker
authors.forename: A
authors.initials: A
authors.lastname: Supperamohan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D006801:Humans; D060828:Induction Chemotherapy / Q000009:adverse effects / Q000379:methods*; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents