title: Indications and outcomes of antifungal therapy in French patients with haematological conditions or recipients of haematopoietic stem cell transplantation.
abstract: OBJECTIVE
  Invasive fungal disease (IFD) remains a major concern in patients with haematological conditions. We describe diagnoses, therapeutic management and outcomes in unselected consecutive patients from haematological facilities treated for suspected or documented IFD.
  
  
  METHODS
  In this observational prospective study, children/adults with haematological conditions or haematopoietic stem cell transplantation (HSCT) were recruited upon start of non-prophylactic systemic antifungal treatment in 37 French haematological facilities (December 2007 to December 2008). IFD episodes were classified according to the 2008 EORTC/MSG criteria.
  
  
  RESULTS
  The cohort included 419 patients (298 adults and 121 children): 88% haematological malignancies, 28% HSCT recipients and 68% neutropenic. Patients had 423 IFD episodes: 21% mycologically documented (59% probable/proven aspergillosis, 32% proven candidiasis and 9% probable/proven other IFD) and 20% classified as possible IFD. The remaining cases were assigned to two groups: febrile neutropenia (34%) and unclassified (25%), 9% of which were classified as possible/probable/proven IFD by day 7. Treatment was thus initiated early in 59% of patients; liposomal amphotericin B and caspofungin were the most common single-agent therapies. The 12 week mortality was 18% for probable/proven aspergillosis, 15% for proven candidiasis, 10% for probable/proven other IFD, 9% for possible IFD, 3% for febrile neutropenia and 12% for unclassified episodes (log rank P = 0.016); it was dependent on age, complete remission of underlying haematological disease and mechanical ventilation.
  
  
  CONCLUSIONS
  In this comprehensive sample of haematological patients receiving antifungal treatment, we observe a widespread resort to early therapy and a low mortality rate, including in patients with probable or proven IFD.
authors: Pôle d'oncologie et d'hématologie, Hôpital de Hautepierre, Strasbourg, France. raoul.herbrecht@chru-strasbourg.fr
authors: Raoul
authors: R
authors: Herbrecht
authors: Denis
authors: D
authors: Caillot
authors: Catherine
authors: C
authors: Cordonnier
authors: Anne
authors: A
authors: Auvrignon
authors: Anne
authors: A
authors: Thiébaut
authors: Benoît
authors: B
authors: Brethon
authors: Mauricette
authors: M
authors: Michallet
authors: Nizar
authors: N
authors: Mahlaoui
authors: Yves
authors: Y
authors: Bertrand
authors: Paul
authors: P
authors: Preziosi
authors: Fabrice
authors: F
authors: Ruiz
authors: Norbert-Claude
authors: NC
authors: Gorin
authors: Jean-Pierre
authors: JP
authors: Gangneux
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005602:France; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy* / Q000401:mortality; D011446:Prospective Studies; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents