Combination Antifungal Therapy For Invasive Fungal Infections In Haematological Patients

ObjectiveNowadays invasive fungal infections (IFI) are one of the major causes of mortality in patients with haematological malignancies. This study was conducted to evaluate the feasibility, efficacy and toxicity of combination antifungal therapies as primary or salvage treatment of IFI in those patients.MethodsForty-five patients with haematological malignancies receiving combination antifungal therapy for IFI in the period between 2006 and 2010 were retrospectively analysed. Efficacy and toxicity were documented at the end of the combination therapy. Survival was evaluated at the end of therapy and 12 weeks after the start of treatment.ResultsAt the end of combination therapy, favourable response was 60.0%. Among patients with infection of identified pathogens, the response rate was 50%for both aspergillosis and candidiasis. Univariate analysis showed that the status of the basic disease(P=0.018),ANC recovery(P=0.010) and duration of combination therapy(P=0.026) were significantly associated with favorable outcome. Multivariate analysis showed that the ANC recovery was the independent factor of the outcome. The 12-week survival of these patients was 75.6%excluding the ones lost follow up.18 patients developed the drug related adverse events during the combination therapy, and most of them were well tolerated.ConclusionsCombination antifungal therapy especially as salvage treatment of IFI is feasible, efficient and generally well tolerated in haematological patients. Although our results seem encouraging, they should be evaluated using large scale, prospective, controlled randomised studies in the future.