Resultados de profilaxis con itraconazol 800 mg/día vía oral en adultos con leucemia aguda y neutropenia de alto riesgo. Hospital del Salvador 2006-2008

Resumen

ITRACONAZOLE 800 MG  FOR THE PROPHYLAXIS OF FUNGAL INFECTIONS IN PATIENTS WITH ACUTE LEUKEMIA AND SEVERE NEUTROPENIA

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.