1. Preemptive Antifungal Therapy for Febrile Neutropenic Hematological Malignancy Patients in China
- Author
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Xiaoling Guo, Jinhai Ren, Wei Yuan, Xiaonan Guo, and Shengxin Cai
- Subjects
0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,China ,Antifungal Agents ,Adolescent ,030106 microbiology ,Neutropenia ,law.invention ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Randomized controlled trial ,law ,Clinical Research ,Internal medicine ,Hematologic Agents ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Adverse effect ,Survival rate ,Aged ,Febrile Neutropenia ,Voriconazole ,business.industry ,Incidence (epidemiology) ,Mortality rate ,General Medicine ,Middle Aged ,medicine.disease ,Hematologic Diseases ,Survival Rate ,Mycoses ,Hematologic Neoplasms ,Female ,business ,Febrile neutropenia ,medicine.drug - Abstract
BACKGROUND The aim of this study was to evaluate the efficiency, adverse effects, and pharmacoeconomic impact of empirical and preemptive antifungal therapy for febrile neutropenic hematological malignancy patients in China. MATERIAL AND METHODS Patients with febrile neutropenia during hematological malignancy were randomly divided into an empirical group and a preemptive group. The preemptive antifungal treatment was initiated if patient status was confirmed by clinical manifestation, imaging diagnosis, 1-3-β-D glucan(G) testing, and galactomannan (GM) test. The treatment was ended 2 weeks later if the patient was recovered from neutropenia. Voriconazole was used as the first-line medicine. All patients received intravenous administration of voriconazole every 12 h, with an initiating dose of 400 mg, then the dose was reduced to 200 mg. RESULTS The overall survival rate was 97.1% and 94.6% in the empirical group and preemptive group, respectively, with no significant difference observed (χ²=1.051, P=0.305). However, the occurrence rate of invasive fungal disease (IFD) in the preemptive group was 9.2% vs. 2.2% in the empirical group. Moreover, the mortality rate due to IFD was 0.7% and 2.3% for the empirical group and preemptive group, respectively. The average duration and cost of preemptive antifungal therapy were 13.8±4.7 days and 8379.00±2253.00 RMB, respectively, which were lower than for empirical therapy. However, no significant differences were observed for incidence of adverse effects and hospital stay between the 2 groups. CONCLUSIONS Preemptive antifungal therapy for patients with febrile neutropenic hematological malignancy demonstrated a similar survival rate as with empirical therapy but is economically favorable in a Chinese population.
- Published
- 2016