Document Detail


High-dose caspofungin combination antifungal therapy in patients with hematologic malignancies and hematopoietic stem cell transplantation.
MedLine Citation:
PMID:  17245424     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Pneumocandins have concentration-dependent antifungal activity and higher dose of caspofungin (HD-CAP) in combination with other licensed antifungal therapy (OLAT) may improve response. Thirty-four patients who received HD-CAP were compared with 63 patients who received standard dose (SD)-CAP. There were no differences between the groups in either patient or disease characteristics. Significantly more patients in the HD-CAP arm had extrapulmonary infections (29 vs 8% in SD group; P=0.0053), and non-Aspergillus species infection (21 vs 6%; P=0.05) and had received prior antifungal therapy (71 vs 33%; P=0.0004). No serious adverse reactions were noted in patients receiving HD- or SD-CAP therapy. Twelve weeks after treatment commenced 44% had a complete or partial response compared with 29% in SD-CAP group (P=0.1). Logistic regression analysis showed a significant probability of a favorable outcome at 12 weeks in patients who received HD-CAP (OR 3.066, 95% CI, 1.092-8.61; P=0.033). This may in part reflect higher number of patients in HD group had received granulocyte-macrophage colony-stimulating factor (41 vs 14% in SD group; P=0.04) and/or interferon gamma (26 vs 5% in SD group; P=0.003) immune enhancement. Further studies are needed to evaluate efficacy of HD-CAP in severely immunosuppressed cancer patients with invasive fungal infections.
Authors:
A Safdar; G Rodriguez; K V I Rolston; S O'Brien; I F Khouri; E J Shpall; M J Keating; H M Kantarjian; R E Champlin; I I Raad; D P Kontoyiannis
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Bone marrow transplantation     Volume:  39     ISSN:  0268-3369     ISO Abbreviation:  Bone Marrow Transplant.     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-01-24     Completed Date:  2007-03-27     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  8702459     Medline TA:  Bone Marrow Transplant     Country:  England    
Other Details:
Languages:  eng     Pagination:  157-64     Citation Subset:  IM    
Affiliation:
Department of Infectious Diseases, Infection Control, and Employee Health, MD Anderson Cancer Center, Houston, TX 77030, USA. asafdar@mdanderson.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Antifungal Agents / therapeutic use*,  toxicity
Dose-Response Relationship, Drug
Drug Therapy, Combination
Echinocandins
Female
Granulocyte-Macrophage Colony-Stimulating Factor / therapeutic use
Hematologic Neoplasms / complications*,  drug therapy*,  therapy
Hematopoietic Stem Cell Transplantation / adverse effects,  methods*
Humans
Infection / chemically induced
Interferon-gamma / therapeutic use
Male
Middle Aged
Peptides, Cyclic / administration & dosage*,  toxicity
Remission Induction
Retrospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antifungal Agents; 0/Echinocandins; 0/Peptides, Cyclic; 0/caspofungin; 82115-62-6/Interferon-gamma; 83869-56-1/Granulocyte-Macrophage Colony-Stimulating Factor
Comments/Corrections
Comment In:
Bone Marrow Transplant. 2007 Feb;39(3):129-31   [PMID:  17245422 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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