[Itraconazole 800 mg for the prophylaxis of fungal infections in patients with acute leukemia and severe neutropenia].
BACKGROUND
Systemic fungal infections and specifically invasive aspergillosis (IA) are associated with a high morbi-mortality rate in patients with hematologic malignancies. Itraconazole kinetic studies show that plasma levels are not satisfactory, even though there is a reduction of the severity in clinical cases.


OBJECTIVE
To evaluate the results of oral prophylaxis with high dose itraconazole, 400 mg bid, among patients with adult acute leukemia.


METHODS
Prospective analysis of 93 high risk febrile episodes (with an absolute neutrophil count of less than 500 x mm3 for more 10 days), that occurred in 76 patients.


RESULTS
Seventy five percent of episodes occurred in patients with acute myeloid leukemia and 25% in patients with acute lymphoblastic leukemia. Fifty two percent occurred during the induction of chemotherapy. Median duration of severe neutropenia was 21 days (range 10-48). Median duration of itraconazole prophylaxis was 17 days (range 6-34). A low frequency of invasive fungal infections was observed (17%). According to diagnostic criteria, 5% of episodes corresponded to persistent fever , 1% and 11% of episodes, to probable or possible IA, respectively. No confirmed or proven IA was observed. Mortality of IA was 18%. No serious adverse events due to itraconazole were observed.


CONCLUSIONS
The use of high dose itraconazole prophylaxis in adult patients with acute leukemia and severe neutropenia was associated to low incidence and mortality of invasive mycoses.
Unidad de Hematología Intensiva, Hospital del Salvador, Santiago, Chile. docandrade@yahoo.es
Alejandro
A
Andrade M
Barbara
B
Puga L
Carolina
C
Guerra C
Javiera
J
Molina E
Marisa
M
Capurro C
D000208:Acute Disease; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001228:Aspergillosis / Q000517:prevention & control; D005260:Female; D005334:Fever / Q000188:drug therapy; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage* / Q000009:adverse effects; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000517:prevention & control*; D009503:Neutropenia / Q000139:chemically induced / Q000188:drug therapy*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011446:Prospective Studies; D055732:Pulmonary Aspergillosis / Q000517:prevention & control; D055815:Young Adult
D000935:Antifungal Agents; D017964:Itraconazole