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Type: Journal article
Title: Early implementation of antifungal therapy in the management of febrile neutropenia is associated with favourable outcome during induction chemotherapy for acute leukaemias
Author: Khalafallah, A.
Maiwald, M.
Hannan, T.
Abell, S.
Staker, L.
Supperamohan, A.
Citation: Internal Medicine Journal, 2012; 42(2):131-136
Publisher: Blackwell Publishing Asia
Issue Date: 2012
ISSN: 1444-0903
Statement of
A. Khalafallah, M. Maiwald, T. Hannan, S. Abell, J. Staker and A. Supperamohan
Abstract: Background:  Mortality related to induction chemotherapy during the treatment of acute leukaemias (AL) has been estimated at 5–20%, and this increases with age. Fungal infection remains one of the major causes of morbidity and mortality and is considered an obstacle to the successful management of acute leukaemias. Methods:  We retrospectively analysed all patients treated for acute leukaemias at a single institution between July 2006 and January 2009, to assess the impact of early antifungal therapy on outcome during induction chemotherapy. There were 44 episodes of induction chemotherapy, with a median age of patients of 61 years (range 18–81), including 29 patients with acute myeloid leukaemia, 9 with acute lymphoblastic leukaemia and 6 with relapsed AL. The median age was 61 years (range 18–81), and 20 patients were over the age of 60 years. Results:  All patients who developed febrile neutropenia received broad-spectrum antibiotics. Early empirical antifungal treatment was commenced with voriconazole (15 patients) or caspofungin (12 patients) if the febrile neutropenia did not resolve after 72 h of antibiotic therapy, in conjunction with radiological changes consistent with possible fungal infection. None of the patients succumbed during induction chemotherapy. The 120-day mortality rate after the induction therapy was 2.2%, without any incidence of invasive fungal disease. Conclusion:  Our analysis shows that early empirical treatment for fungal infection with voriconazole or caspofungin is associated with a favourable outcome of induction therapy for acute leukaemias. Further studies to confirm this finding are warranted.
Keywords: acute leukaemia; induction chemotherapy; fungal infection; empirical; outcome.
Rights: © 2011 The Authors
RMID: 0020117324
DOI: 10.1111/j.1445-5994.2011.02638.x
Appears in Collections:Medicine publications

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