29 July 2018 : Clinical Research
Efficacy of Caspofungin in Unclassified Invasive Fungal Infection Cases: A Retrospective Analysis of Patients with Hematological Malignancies in ChinaXiaohui Zhang1ABE, Jiong Hu2BC, Yu Hu3BC, He Huang4BC, Jie Jin4BC, Juan Li5BC, Qifa Liu6BCF, Zonghong Shao7BCF, Jianxiang Wang8BCD, Quanshun Wang9BCF, Depei Wu10CF, Xiaojun Huang1ABE*
Med Sci Monit 2018; 24: CLR5258-5270
BACKGROUND: The management of invasive fungal infection (IFI) is challenging in immunocompromised patients who do not fully satisfy the EORTC/MSG diagnostic criteria of proven or probable IFI. Our study assessed caspofungin efficacy in 582 Chinese patients with hematological malignancies exhibiting unclassified signs or symptoms of IFI.
MATERIAL AND METHODS: This retrospective study included caspofungin treatment outcomes of an unclassified group A (n=401) of patients without microbiological or biomarker results and group B (n=181) patients with positive microbiological or biomarker results. Factors that correlated with clinical outcomes were determined using univariate and multivariate analyses.
RESULTS: Cough (41.8%), expectoration (29.6%), and chest tightness (14.6%) were the most common clinical features, and changes in CT images (88.1%) were more frequently detected than in X-ray images (19.6%) in all patients. Favorable response rates for caspofungin as first-line treatment were 58.2% for group A and 56.3% for group B. Eastern Cooperative Oncology Group (ECOG) score, cardiovascular disease, hemoptysis, and absolute neutrophil count (ANC) <1000/mm³ before antifungal treatment without recovery were associated with unfavorable clinical outcome (P<0.05 for all). Cough and ANC recovery >1000/mm3 were significantly associated with favorable (complete or partial resolution) outcome.
CONCLUSIONS: Caspofungin was effective for treating unclassified IFIs of immunocompromised patients. Cardiovascular disease, ECOG score, cough, and/or hemoptysis, as well as ANC count, represent a potential index for estimating response of unclassified IFI patients to caspofungin treatments.
Keywords: Antifungal Agents, Fruiting Bodies, Fungal, Hematologic Neoplasms
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