title: Treatment of invasive fungal disease using anidulafungin alone or in combination for hematologic patients with concomitant hepatic or renal impairment.
abstract: BACKGROUND
  Invasive fungal disease (IFD) treatment is challenging in hematologic patients due to drug interactions and toxicities that limit the use of the antifungal agents.
  
  
  OBJECTIVE
  To analyze retrospectively in terms of safety and potential efficacy anidulafungin therapy, alone or in combination.
  
  
  METHODS
  Our institutional guidelines recommended anidulafungin treatment in hematologic patients with suspected IFD and concomitant renal or liver impairment (to avoid drug interactions and preserve organ function).
  
  
  RESULTS
  From 2008 to 2013, 24 episodes of IFD occurring in 21 patients were classified as proven (4 cases), probable (15 cases) and possible (5 cases). Anidulafungin was administered alone (13%) or in combination (88%). Eight (33%) episodes were resolved, using monotherapy (1 out of 3, 33%) or a combined therapy (7 out of 21, 33%). Twelve cases (50%) were registered as failure (death due to IFD progression in 4 patients, and treatment change due to lack of efficacy in 8), and 4 cases (17%) were not evaluable (death unrelated to the IFD). Anidulafungin was not withdrawn in any case due to toxicity.
  
  
  CONCLUSIONS
  Anidulafungin therapy, alone or in combination, could be considered in hematologic patients with IFD and concomitant liver or renal impairment. Due to the low number of patients, we cannot draw any conclusion about efficacy.
authors: Hematology Department of the Hospital Universitario La Fe, Valencia, Spain. Electronic address: montesinos_pau@gva.es.
authors: Pau
authors: P
authors: Montesinos
authors: Hematology Department of the Hospital Universitario La Fe, Valencia, Spain.
authors: Rebeca
authors: R
authors: Rodríguez-Veiga
authors: Hematology Department of the Hospital Universitario La Fe, Valencia, Spain.
authors: David
authors: D
authors: Martínez-Cuadrón
authors: Hematology Department of the Hospital Universitario La Fe, Valencia, Spain.
authors: Blanca
authors: B
authors: Boluda
authors: Hematology Department of the Hospital Universitario La Fe, Valencia, Spain.
authors: Inés
authors: I
authors: Navarro
authors: Hematology Department of the Hospital Universitario La Fe, Valencia, Spain.
authors: Belen
authors: B
authors: Vera
authors: Hematology Department of the Hospital Universitario La Fe, Valencia, Spain.
authors: Carmen M
authors: CM
authors: Alonso
authors: Hematology Department of the Hospital Universitario La Fe, Valencia, Spain.
authors: Jaime
authors: J
authors: Sanz
authors: Hematology Department of the Hospital Universitario La Fe, Valencia, Spain.
authors: Francisca
authors: F
authors: López-Chulia
authors: Hematology Department of the Hospital Universitario La Fe, Valencia, Spain.
authors: Guillermo
authors: G
authors: Martín
authors: Intensive Care Unit Department of the Hospital Universitario La Fe, Valencia, Spain.
authors: Rosa
authors: R
authors: Jannone
authors: Hematology Department of the Hospital Universitario La Fe, Valencia, Spain.
authors: Guillermo
authors: G
authors: Sanz
authors: Hematology Department of the Hospital Universitario La Fe, Valencia, Spain.
authors: Aima
authors: A
authors: Lancharro
authors: Hematology Department of the Hospital Universitario La Fe, Valencia, Spain.
authors: Isabel
authors: I
authors: Cano
authors: Hematology Department of the Hospital Universitario La Fe, Valencia, Spain.
authors: Javier
authors: J
authors: Palau
authors: Hematology Department of the Hospital Universitario La Fe, Valencia, Spain.
authors: Ignacio
authors: I
authors: Lorenzo
authors: Hematology Department of the Hospital Universitario La Fe, Valencia, Spain.
authors: Isidro
authors: I
authors: Jarque
authors: Infectious Diseases Unit of the Hospital Universitario La Fe, Valencia, Spain.
authors: Miguel
authors: M
authors: Salavert
authors: Intensive Care Unit Department of the Hospital Universitario La Fe, Valencia, Spain.
authors: Paula
authors: P
authors: Ramírez
authors: Hematology Department of the Hospital Universitario La Fe, Valencia, Spain.
authors: Miguel Ángel
authors: MÁ
authors: Sanz
mesh_terms: D000328:Adult; D000368:Aged; D000077612:Anidulafungin; D000935:Antifungal Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D054714:Echinocandins / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D008107:Liver Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications* / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D000077612:Anidulafungin
keywords: Alto-riesgo; Anidulafungin; Anidulafungina; Enfermedad fúngica invasiva; Hematologic malignancies; High-risk; Invasive fungal disease; Neoplasias hematológicas