Itraconazole 800 mg for the prophylaxis of fungal infections in patients with acute leukemia and severe neutropenia

作者：Andrade M Alejandro; Puga L Barbara; Guerra C Carolina; Molina E Javiera; Capurro C Marisa

来源：Revista Medica de Chile, 2011, 139(9): 1128-1134.

DOI：10.4067/S0034-98872011000900003

• Aspergillosis
• Itraconazole
• Leukemia, lymphoid
• Leukemia, myeloid
• Mycoses fungoides

Background: Systemic fungal infections and specifically invasive aspergillosis (IA) are associated with a high morbi-mortality rate in patients with hematologic malignancies. Itraconazole kinetic studies show that plasma levels are not satisfactory, even though there is a reduction of the severity in clinical cases. Aim: To evaluate the results of oral prophylaxis with high dose itraconazole, 400 mg bid, among patients with adult acute leukemia. Material and Methods: Prospective analysis of 93 high risk febrile episodes (with an absolute neutrophil count of less than 500 x mm(3) for more 10 days), that occurred in 76 patients. Results: Seventy five percent of episodes occurred in patients with acute myeloid leukemia and 25% in patients with acute lymphoblastic leukemia. Fifty two percent occurred during the induction of chemotherapy Median duration of severe neutropenia was 21 days (range 10-48). Median duration of itraconazole prophylaxis was 17 days (range 6-34). A low frequency of invasive fungal infections was observed (17%). According to diagnostic criteria, 5% of episodes corresponded to persistent fever, 1% and 11% of episodes, to probable or possible IA, respectively No confirmed or proven IA was observed. Mortality of IA was 18%. No serious adverse events due to itraconazole were observed. Conclusions: The use of high dose itraconazole prophylaxis in adult patients with acute leukemia and severe neutropenia was associated to low incidence and mortality of invasive mycoses. (Rev Med Chile 2011; 139: 1128-1134).

• 出版日期2011-9