title: Clinical outcomes and prognostic factors of empirical antifungal therapy with itraconazole in the patients with hematological malignancies: a prospective multicenter observational study in Korea.
abstract: OBJECTIVE
  To identify prognostic factors for the outcomes of empirical antifungal therapy, we performed a multicenter, prospective, observational study in immunocompromised patients with hematological malignancies.
  
  
  METHODS
  Three hundred seventy-six patients (median age of 48) who had neutropenic fever and who received intravenous (IV) itraconazole as an empirical antifungal therapy for 3 or more days were analyzed. The patients with possible or probable categories of invasive fungal disease (IFD) were enrolled.
  
  
  RESULTS
  The overall success rate was 51.3% (196/376). Age >50 years, underlying lung disease (co-morbidity), poor performance status [Eastern Cooperative Oncology Group (ECOG) ≥2], radiologic evidence of IFD, longer duration of baseline neutropenic fever (≥4 days), no antifungal prophylaxis or prophylactic use of antifungal agents other than itraconazole, and high tumor burden were associated with decreased success rate in univariate analysis. In multivariate analysis, age >50 years (p=0.009) and poor ECOG performance status (p=0.005) were significantly associated with poor outcomes of empirical antifungal therapy. Twenty-two patients (5.9%) discontinued itraconazole therapy due to toxicity.
  
  
  CONCLUSIONS
  We concluded that empirical antifungal therapy with IV itraconazole in immunocompromised patients is effective and safe. Additionally, age over 50 years and poor performance status were poor prognostic factors for the outcomes of empirical antifungal therapy with IV itraconazole.
authors: Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea. minbrmmd@yuhs.ac.
authors: Jin Seok
authors: JS
authors: Kim
authors: June-Won
authors: JW
authors: Cheong
authors: Ho Jin
authors: HJ
authors: Shin
authors: Jong Wook
authors: JW
authors: Lee
authors: Je-Hwan
authors: JH
authors: Lee
authors: Deok-Hwan
authors: DH
authors: Yang
authors: Won Sik
authors: WS
authors: Lee
authors: Hawk
authors: H
authors: Kim
authors: Joon Seong
authors: JS
authors: Park
authors: Sung-Hyun
authors: SH
authors: Kim
authors: Yang Soo
authors: YS
authors: Kim
authors: Jae-Yong
authors: JY
authors: Kwak
authors: Yee Soo
authors: YS
authors: Chae
authors: Jinny
authors: J
authors: Park
authors: Young Rok
authors: YR
authors: Do
authors: Yoo Hong
authors: YH
authors: Min
mesh_terms: D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D019337:Hematologic Neoplasms; D006801:Humans; D016867:Immunocompromised Host; D017964:Itraconazole / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D056910:Republic of Korea
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole
keywords: Hematological malignancy; empirical antifungal therapy; itraconazole; prognosis