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Revista médica de Chile

versão impressa ISSN 0034-9887

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ANDRADE M, Alejandro et al. Itraconazole 800 mg for the prophylaxis of fungal infections in patients with acute leukemia and severe neutropenia. Rev. méd. Chile [online]. 2011, vol.139, n.9, pp.1128-1134. ISSN 0034-9887.  http://dx.doi.org/10.4067/S0034-98872011000900003.

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 mm3 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.

Palavras-chave : Aspergillosis; Itraconazole; Leukemia; lymphoid; Leukemia, myeloid; Mycoses fungoides.

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