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국내 혈액질환 환자에서 침습성 진균 감염의 구제치료로서 Caspofungin의 효과와 안전성

Efficacy and Safety Profile of Caspofungin as a Salvage Therapy for Invasive Fungal Infections in Korean Patients with Hematologic Diseases

감염과화학요법 2005년 37권 5호 p.247 ~ 254
최수미, 박선희, 이동건, 최정현, 유진홍, 민우성, 신완식, 김춘추,
소속 상세정보
최수미 ( Choi Su-Mi ) - 가톨릭대학교 의과대학 내과학교실
박선희 ( Park Sun-Hee ) - 가톨릭대학교 의과대학 내과학교실
이동건 ( Lee Dong-Gun ) - 가톨릭대학교 의과대학 내과학교실
최정현 ( Choi Jung-Hyun ) - 가톨릭대학교 의과대학 내과학교실
유진홍 ( Yoo Jin-Hong ) - 가톨릭대학교 의과대학 내과학교실
민우성 ( Min Woo-Sung ) - 가톨릭대학교 의과대학 내과학교실
신완식 ( Shin Wan-Shik ) - 가톨릭대학교 의과대학 내과학교실
김춘추 ( Kim Chun-Choo ) - 가톨릭대학교 의과대학 내과학교실

Abstract


Background: Invasive fungal infection (IFI) is an important cause of morbidity and mortality in patients with hematologic malignancy. Patients with IFI who fail to standard therapy have poor prognoses. We investigated the efficacy and safety of caspofungin (CAS) in Korean adults with hematologic diseases and IFI who did not respond to the conventional antifungal therapy.

Materials & Methods: Patients with IFI refractory or intolerant to standard antifungal therapy received CAS 50 mg IV daily after 70 mg loading dose on day 1. Efficacy and safety of CAS were assessed in patients who received more than one dose. Favorable response [complete (CR) or partial (PR)] was defined as significant improvement of all clinical symptoms, signs, and radiologic abnormalities.

Results: From Feb. 2004 to Feb. 2005, 55 patients who met the inclusion criteria were enrolled. There were 32 male and 23 female patients with mean age of 38.2 years (range, 16-65). Underlying diseases were acute leukemia (33 cases), myelodysplastic syndrome (12 cases), chronic myelogenous leukemia (3 cases), and other hematologic diseases (7 cases). Thirty-six patients were receiving chemotherapy and 13 patients were under hematopoietic stem cell transplantation (HSCT). The number of proven, probable, possible, and indeterminate IFI cases was 1, 5, 47, and 2, respectively. Conventional amphotericin B, intravenous itraconazole, and liposomal amphotericin B were administered for average of 14.9 days prior to administering CAS. Mean duration of CAS therapy was 12.8 days (range, 1-45). Twenty-three patients (41.8%) showed favorable responses (CR:PR=8:15) at the end of CAS therapy. Chemotherapy group, neutropenic state, remitted state of underlying disease, and no steroid therapy were significant prognostic factors for favorable response. Eight (14.5%) patients developed drug-related adverse events such as fever, skin eruption, and hepatic dysfunction which were reversible after discontinuation of CAS. Drug-related nephrotoxicity was not observed.

Conclusion: On the basis of our investigation, CAS was effective and safe as a salvage therapy of refractory IFI or as an alternative for patients intolerant to standard antifungal agents.

키워드

Invasive Fungal Infection;Caspofungin;Salvage Therapy

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