Efficacy and Safety of Micafungin As Salvage Treatment for Invasive Fungal Disease in Patients with Hematologic Malignancies

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4628-4628
Author(s):  
Li Gao ◽  
Ren Lin ◽  
Min Dai ◽  
Jing Sun ◽  
Zhiping Fan ◽  
...  
Keyword(s):  
Adverse Event ◽  
Amphotericin B ◽  
Median Time ◽  
Salvage Therapy ◽  
Invasive Fungal Disease ◽  
Hematologic Malignancies ◽  
Fungal Disease ◽  
Salvage Treatment ◽  
Efficacy And Safety ◽  
First Line

Abstract Objective To explore the efficacy and safety of micafungin as salvage treatment for invasive fungal disease(IFD) in patients with hematologic malignancies. Methods A retrospective, observational, sequential cohort study was performed between Feb 2012 and June 2015 at southern medical university nanfang Hospital. We selected a group of 51 patients who either refractory or intolerant to first-line antifungal therapies, received micafungin as salvage therapy. Of the 51 patients, IFD was proven in 5 and probable in 46 patients. The predominant cause for treatment switch to micafungin was refractory therapy in 33 patients, followed by intolerance in 15 patients or both in 3 patients. For their first-line antifungal therapies of IFD, 34 patients received voriconazole, 7 patients received itraconazole, 2 patients received amphotericin B,1 patients received caspofungin,1 patients received posaconazole and 6 patients received voriconazole combined amphotericin B. The median duration of antifungal treatment before salvage therapy was 26 days (range, 4 to 57 days). The successful resolution rates、the median time of micafungin treatment, the drug related adverse events and overall survival were assessed. Results All of the patients were treated with 150 mg/d micafungin. The median time of micafungin treatment was 23 days (range,12-72 days). The success rate was 64.7%, including 16 achieved complete response, 17 achieved partial response and 18 patients had no overall response (failure in 9 patients, 2 patient with stable disease and 7 patients died). Only one patient experienced an adverse event. No patient discontinued micafungin therapy due to an adverse event. Conclusions This study demonstrated that micafungin was efficacy and safety as salvage treatment IFD in patients with hematologic malignancies. Disclosures No relevant conflicts of interest to declare.

Posaconazole oral suspension as salvage therapy for invasive fungal disease in patients with hematological diseases

2019 ◽  
Vol 14 (6) ◽  
pp. 477-488 ◽  
Author(s):  
Sudong Zhang ◽  
Ping Zhang ◽  
Zhao Wang ◽  
Li Liu ◽  
Yi He ◽  
...  
Keyword(s):  
Salvage Therapy ◽  
Invasive Fungal Disease ◽  
Fungal Disease ◽  
Oral Suspension ◽  
Hematological Diseases

Safety, efficacy, and time to clinical response with bevacizumab plus FOLFIRI regimen in metastatic colorectal cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15138-e15138
Author(s):  
S. Tomao ◽  
G. Spinelli ◽  
L. Rossi ◽  
G. Pasciuti ◽  
G. Arcangeli ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Clinical Response ◽  
Median Time ◽  
Progression Free Survival ◽  
Phase Iii ◽  
Clinical Activity ◽  
Efficacy And Safety ◽  
First Line ◽  
Ecog Ps

e15138 Background: Bevacizumab (BEV) has shown clinical activity in metastatic colorectal cancer patients (mCRC)and randomised phase III trials have demonstrated that this agent significantly improves overall and/or progression-free survival when added to first-line irinotecan based chemotherapy (CT) regimens. We evaluated the efficacy and safety of BEV plus FOLFIRI (irinotecan, 5- fluorouracil, and leucovorin) as first line treatment in 27 consecutive metastatic colorectal cancer cases, with the primary end point to calculate the median time to clinical response with this chemotherapeutic schedule. Methods: Between October 2007 and January 2008 we collected the data on 27 patients with mCRC treated with first line chemotherapy with BEV plus FOLFIRI. Elegibility criteria had to be: mCRC; no prior CT for metastatic disease; ECOG PS 0/1, adequate organ function; no CNS metastases. The treatment consisted of a minimum of six cycles of irinotecan plus infusional 5-FU/LV according to the classical FOLFIRI schedule; BEV (5mg/kg) was given on day 1 with CT and then every 2 weeks until disease progression. Safety and response were assessed at the time of first CT and every 4 weeks thereafter. Results: 27 pts were evaluable (male 18; median age 61 years (range 45–77), ECOG PS 0: 52%, PS 1: 48%. The sites of metastases were: liver (15 pts), lung (5 pts), liver and lung (5 pts), peritoneal wall (2 pts).Median follow-up was 18 weeks. Two patients had complete response(CR) and 13 pts partial response (PR), with an overall response rate of 57.7%. Five patients had stable disease and 6 patients showed progressive disease. A clinical benefit was demonstrated in 77 % of pts. We observed a median time to clinical response of 11 weeks, evaluated with tumor markers and with CT/NMR/US examinations. A grade 3 or 4 neutropenia was detected in 39% of pts and grade 2 or 3 hypertension in 9%. We did’nt observe cases of thrombosis, bleeding and gastrointestinal perforation, sometimes related to the use of BEV. Conclusions: In this little experience the efficacy and safety of BEV associated with FOLFIRI schedule, a first line therapy in mCRC,is consistent with results from other previous studies, showing moreover a short time to clinical response with this association. No significant financial relationships to disclose.

The efficacy and safety of fasciectomy and fasciotomy for Dupuytren’s contracture in European patients: a structured review of published studies

2011 ◽  
Vol 36 (5) ◽  
pp. 396-407 ◽  
Author(s):  
S. M. Crean ◽  
R. A. Gerber ◽  
M. P.Hellio Le Graverand ◽  
D. M. Boyd ◽  
J. C. Cappelleri
Keyword(s):  
Adverse Event ◽  
Median Time ◽  
Surgical Complications ◽  
Postoperative Outcomes ◽  
Dupuytren’S Contracture ◽  
Efficacy And Safety ◽  
Recurrence Rates ◽  
Dupuytren's Contracture ◽  
The Mean

A structured review of published papers was done to assess the efficacy and safety of fasciectomy and fasciotomy in European patients with Dupuytren’s contracture. The outcomes varied across 48 studies. For fasciectomy, outcomes and results were as follows: the proportions of patients with a 100% correction in contracture angle ranged from 61 to 97%, the mean improvement in contracture angle ranged from 58 to 79%, and cases judged excellent/good ranged from 63 to 90%. Fasciotomy had similar outcomes, with a mean improvement in contracture angle ranging from 46 to 88%. Immediate failures upon recovery were reported for both procedures. The average recurrence rates were 39% after a fasciectomy and 62% after a fasciotomy at a median time of about 4 years. Overall, about 20% of fasciectomy and fasciotomy patients experienced an adverse event. In summary, postoperative outcomes were successful, but surgical complications were common and recurrence of a contracture was likely within a few years.

Phase 2 Study of Dasatinib in Chinese Patients (Pts) with Chronic Myeloid Leukemia (CML) in Chronic Phase (CP) or Advanced Phase Who Are Resistant to or Intolerant of Imatinib (IM)

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4434-4434
Author(s):  
Jianxiang Wang ◽  
Xiaojun Huang ◽  
Jianda Hu ◽  
Jianyong Li ◽  
Jie Jin ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Median Time ◽  
Philadelphia Chromosome ◽  
Cytogenetic Response ◽  
Phase 2 ◽  
Efficacy And Safety ◽  
First Line ◽  
Phase 2 Study ◽  
Grade 3

Abstract Abstract 4434 Background: CML has a lower incidence in China than in Western countries and appears to affect a younger population (Au, Int J Hematol 2009). In recent years, IM has become the first-line standard of care across Asia for pts with newly diagnosed CML. In a cohort of Chinese pts, >25% of evaluable pts in CP failed to achieve a CCyR with first-line IM, and response rates were significantly lower in pts with accelerated-phase (AP) or blast-phase (BP) CML (Wang, J Exp Clin Cancer Res 2010). Dasatinib is a highly potent second-generation BCR-ABL inhibitor that has established efficacy and safety in pts with CML or Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) after prior imatinib therapy. Dasatinib is approved by various regulatory authorities worldwide for first-line treatment of Philadelphia chromosome-positive (Ph+) CML in CP. Limited efficacy and safety data are available for second-generation BCR-ABL inhibitors in Chinese pts with CML or Ph+ ALL after imatinib therapy. Methods: In an open-label, single-arm phase 2 study, Chinese pts aged ≥18 years with IM resistant/intolerant CML or Ph+ ALL received dasatinib 100 mg once daily (CP) or 70 mg twice daily for AP/BP or Ph+ ALL. Bone marrow cytogenetic evaluation was performed at months 3 and 6, then every 6 months in CP pts, and was optional for pts with AP/BP or Ph+ ALL. Primary study objectives were to assess rates of major cytogenetic response (MCyR) in CP pts and complete and overall hematologic response (CHR and OHR) in pts with AP/BP or Ph+ ALL. OHR was defined as CHR, no evidence of leukemia, or return to CP. Treatment continued until disease progression or intolerable toxicity. Results: Of 140 enrolled pts, 121 pts had received ≥1 dose of dasatinib and were evaluable (59 with CP, 25 with AP, 35 with BP, and 2 with Ph+ ALL). Of pts with CML-CP or AP/BP/Ph+ ALL, 52 (88%) and 53 (85%) were IM resistant, 4 (7%) and 5 (8%) were IM intolerant, and 3 (5%) and 4 (6%) were both IM resistant and intolerant. Median time from original CML diagnosis to first dasatinib dose was 46.3 months (CP) and 50.2 months (AP/BP/Ph+ ALL). More than half of pts had received prior interferon therapy. At last follow-up, dasatinib therapy had been discontinued by 7 pts (12%) with CP and 43 pts (69%) with AP/BP/Ph+ ALL, due to disease progression or loss of response in 2% and 35%, study drug toxicity in 2% and 11%, stem-cell transplant in 0% and 5%, death in 2% and 2%, and other reasons in 7% and 16%, respectively. After a minimum of 12 months follow-up, MCyR was achieved by 30 pts with CP (51%), 10 pts with AP (40%), and 8 pts with BP/Ph+ ALL (22%). In pts with CP, median time to MCyR was 12 weeks and no patient lost MCyR. Complete cytogenetic response was achieved by 25 pts with CP (44%), 7 pts with AP (28%), and 6 pts with BP/Ph+ ALL (16%). CHR was achieved by 54 pts with CP (92%), 13 pts with AP (52%), and 6 pts (16%) with BP/Ph+ ALL. In CP pts, most (51/54) who achieved CHR did so within 2 months. Median times to CHR were 16 and 12 weeks for pts with AP and BP/Ph+ ALL, respectively. After 12 months, 3 pts in CP, 2 pts in AP, and 1 pt in BP had lost their CHR. OHR was achieved by 23 and 13 pts (92% and 35%) with AP and BP/Ph+ ALL, respectively. In safety assessments (Table), grade 3/4 cytopenia was frequent but managed by dose interruption/reduction or supportive care, with 1 pt discontinued for cytopenia. Pleural effusion of any grade occurred in 15%, 20%, and 22% of pts with CP, AP, and BP/Ph+ ALL, respectively. Grade 3/4 pleural effusion occurred in 1 pt with CML-CP (2%) and 5 pts with AP/BP/Ph+ ALL (8%). Conclusions: The current study confirms the efficacy and safety of dasatinib in Chinese pts with CML or Ph+ ALL that is resistant or intolerant to IM. Results were consistent with data from global trial populations. Disclosures: No relevant conflicts of interest to declare.

scholarly journals 2596. Invasive Fungal Disease in Patients with GATA2 Variant Hematologic Malignancy

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S902-S902
Author(s):  
Tyler D Bold ◽  
Rahul S Vedula ◽  
Matthew P Cheng ◽  
Francisco M Marty ◽  
R Coleman Lindsley
Keyword(s):  
Hematologic Malignancy ◽  
Retrospective Chart Review ◽  
Invasive Fungal Disease ◽  
Hematologic Malignancies ◽  
Fungal Disease ◽  
Infectious Complications ◽  
Genetic Diagnostics ◽  
Cancer Center ◽  
Sequence Variant ◽  
Wide Range

Abstract Background Patients with hematologic malignancies (HM) are at risk of invasive fungal disease (IFD). Identification of those patients at the highest risk for IFD would help optimize prophylactic or preemptive treatment decisions in this population. We previously found that among patients with myeloid malignancies who develop invasive aspergillosis, 15% had a mutation in the gene GATA2. Here, we report the incidence of IFD in a cohort of patients with HM related to a pathogenic sequence variant of GATA2. Methods We identified 6343 patients cared for at Dana-Farber/Brigham and Women’s Cancer Center between January 2014 and August 2018 who underwent a next-generation sequencing assay of 95 genes recurrently mutated in hematologic malignancy. Those found to have a pathogenic GATA2 sequence variant were selected for retrospective chart review with respect to serious infectious complications including IFD. Results We identified 54 patients with a pathogenic GATA2 variant. 5 had a germline mutation related to familial GATA2 deficiency. The other 49 had a HM, mostly (41/49) acute myeloid leukemia or myelodysplastic syndrome. The frequency of the variant GATA2 allele in this group ranged from 2.5 to 92.0% of sequencing reads. 14 patients were excluded due to lack of sufficient follow-up, often related to treatment at another institution. Of the remaining 35 patients, 13 (37%) had proven/probable invasive fungal infection (IFI). Fourteen others had syndromes consistent with possible IFD. In total, 16 of these 35 patients (46%) received antifungal therapy for proven, probable or possible IFD. Four of the patients not treated with antifungals were diagnosed with a serious infection including 2 cases of Staphylococcus aureus bacteremia, and one case of disseminated Mycobacterium avium complex. Conclusion We identified a high incidence of IFD among patients with HM related to a pathogenic sequence variant of GATA2. The wide range of variant allele frequency observed raises the possibility that either inherited or acquired GATA2 dysfunction could incur predisposition to infection. These data suggest that personalized genetic diagnostics of patients with HM may be useful for assessment of infectious risk. Disclosures All authors: No reported disclosures.

scholarly journals Orbital compartment syndrome following retrobulbar injection of amphotericin B for invasive fungal disease

2016 ◽  
Vol 1 ◽  
pp. 8-10 ◽  
Author(s):  
Frank L. Brodie ◽  
Evan Kalin-Hajdu ◽  
Debbie S. Kuo ◽  
Kristin E. Hirabayashi ◽  
Reza Vagefi ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Amphotericin B ◽  
Invasive Fungal Disease ◽  
Fungal Disease
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