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Infectious Medicine

Novel antifungal agents as salvage therapy for invasive aspergillosis in patients with hematologic malignancies: posaconazole compared with high-dose lipid formulations of amphotericin B alone or in combination with caspofungin

Leukemia volume 22, pages 496–503 (2008)Cite this article

Abstract

In patients with hematologic malignancy, invasive aspergillosis continues to be associated with high mortality even when treated with conventional antifungal therapy. To investigate novel antifungal agents, we compared 53 patients who received posaconazole salvage therapy to 52 contemporary control patients who received high-dose lipid formulation of amphotericin B (HD-LPD/AMB at ⩾7.5 mg kg−1 per day) and 38 other control patients who received caspofungin plus HD-LPD/AMB. Patients in the three groups had similar. The overall response rate to salvage therapy was 40% for posaconazole, 8% for HD-LPD/AMB (P⩽0.001) and 11% for combination therapy (P<0.002). Aspergillosis contributed to the death of 40% of posaconazole group, 65% of the HD-LPD/AMB group and 68% of the combination group (P⩽0.008). By multivariate analysis, posaconazole therapy independently improved response (9.5; 95% confidence interval, 2.8–32.5; P<0.001). HD-LPD/AMB alone or in combination was associated with a significantly higher rate of nephrotoxicity (P⩽0.02) and hepatotoxicity (P<0.03). In conclusion, posaconazole salvage therapy demonstrated greater efficacy and safety than HD-LPD/AMB alone or in combination with caspofungin in the salvage therapy of invasive aspergillosis in hematologic malignancy.

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Acknowledgements

Issam I Raad designed the study and wrote the paper. Hend Hanna did the statistical analysis. Maha Boktour and Harrys Torres coordinated the data collection. Claude Afif and Dimitrios P Kontoyiannis followed up on the patients. Ray Y Hachem coordinated the study and assisted Issam I Raad in writing the paper. Grant support received from Schering-Plough Research Institute, Merck & Co., Enzon, Fujisawa (Astellas).

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Authors and Affiliations

  1. Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    I I Raad, H A Hanna, M Boktour, Y Jiang, H A Torres, C Afif, D P Kontoyiannis & R Y Hachem

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Correspondence to I I Raad.

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Raad, I., Hanna, H., Boktour, M. et al. Novel antifungal agents as salvage therapy for invasive aspergillosis in patients with hematologic malignancies: posaconazole compared with high-dose lipid formulations of amphotericin B alone or in combination with caspofungin. Leukemia 22, 496–503 (2008). https://doi.org/10.1038/sj.leu.2405065

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