Document Detail


Outcome analysis of invasive aspergillosis in hematologic malignancy and hematopoietic stem cell transplant patients: the role of novel antimold azoles.
MedLine Citation:
PMID:  21659609     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Invasive aspergillosis (IA) continues to be a leading cause of morbidity and mortality in hematologic malignancy (HM) patients. We evaluated the prognostic factors for IA in HM patients.
METHODS: In this retrospective study, we included all HM patients diagnosed with proven or probable IA between June 1993 and June 2008.
RESULTS: A total of 449 HM patients were analyzed, the majority of which (75%) had underlying leukemia. Multivariate logistic regression analysis showed that neutropenia for more than two weeks during IA, steroid use, and intensive care admission were independently associated with failure to respond to antifungal therapy, as well as increased IA-attributable mortality (all p-values < .01). Antifungal therapy with an antimold azole-containing regimen (voriconazole or posaconazole) was also independently associated with improved response to treatment, as well as decreased IA-attributable mortality (all p-values < .0001). Survival analysis showed that primary or salvage therapy with a regimen that contained antimold azoles was significantly associated with improved survival (p < .001).
CONCLUSIONS: In HM patients, persistent neutropenia and the need for intensive care are associated with failure to respond to antifungal therapy. Use of novel antimold azoles, either as primary or salvage therapy, improves the overall outcome and IA-attributable death of HM patients with IA.
Authors:
Elizabeth R Ramos; Ying Jiang; Ray Hachem; Christelle Kassis; Dimitrios P Kontoyiannis; Issam Raad
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-06-09
Journal Detail:
Title:  The oncologist     Volume:  16     ISSN:  1549-490X     ISO Abbreviation:  Oncologist     Publication Date:  2011  
Date Detail:
Created Date:  2011-08-01     Completed Date:  2012-01-31     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  9607837     Medline TA:  Oncologist     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1049-60     Citation Subset:  IM    
Affiliation:
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Antifungal Agents / therapeutic use*
Aspergillosis / drug therapy*,  etiology*,  microbiology
Azoles / therapeutic use*
Child
Hematologic Neoplasms / microbiology*
Hematopoietic Stem Cell Transplantation / adverse effects*
Humans
Male
Middle Aged
Prognosis
Retrospective Studies
Salvage Therapy
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/Antifungal Agents; 0/Azoles
Comments/Corrections

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