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KMID : 0191120140290010061
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Journal of Korean Medical Science
2014 Volume.29 No. 1 p.61 ~ p.68
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Success Rate and Risk Factors for Failure of Empirical Antifungal Therapy with Itraconazole in Patients with Hematological Malignancies: A Multicenter, Prospective, Open-Label, Observational Study in Korea
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Kim Soo-Jeong
Cheong June-Won
Min Yoo-Hong
Choi Young-Jin
Lee Dong-Gun
Lee Je-Hwan
Yang Deok-Hwan
Lee Sang-Min
Kim Sung-Hyun
Kim Yang-Soo
Kwak Jae-Yong
Park Jinny
Kim Jin-Young
Kim Hoon-Gu
Kim Byung-Soo
Ryoo Hun-Mo
Jang Jun-Ho
Kim Min-Kyoung
Kang Hye-Jin
Cho In-Sung
Mun Yeung-Chul
Jo Deog-Yeon
Kim Ho-Young
Park Byeong-Bae
Kim Jin-Seok
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Abstract
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We assessed the success rate of empirical antifungal therapy with itraconazole and evaluated risk factors for predicting the failure of empirical antifungal therapy. A multicenter, prospective, observational study was performed in patients with hematological malignancies who had neutropenic fever and received empirical antifungal therapy with itraconazole at 22 centers. A total of 391 patients who had abnormal findings on chest imaging tests (31.0%) or a positive result of enzyme immunoassay for serum galactomannan (17.6%) showed a 56.5% overall success rate. Positive galactomannan tests before the initiation of the empirical antifungal therapy (P=0.026, hazard ratio [HR], 2.28; 95% confidence interval [CI], 1.10-4.69) and abnormal findings on the chest imaging tests before initiation of the empirical antifungal therapy (P=0.022, HR, 2.03; 95% CI, 1.11-3.71) were significantly associated with poor outcomes for the empirical antifungal therapy. Eight patients (2.0%) had premature discontinuation of itraconazole therapy due to toxicity. It is suggested that positive galactomannan tests and abnormal findings on the chest imaging tests at the time of initiation of the empirical antifungal therapy are risk factors for predicting the failure of the empirical antifungal therapy with itraconazole. (Clinical Trial Registration on National Cancer Institute website, NCT01060462)
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KEYWORD
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Hematological Malignancy, Itraconazole, Empirical Antifungal Therapy, Galactomannan Test
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