Efficacy and safety of isavuconazole diagnostic-driven therapy of hematologic malignancies combined with invasive aspergillus pneumonia
Objective:To evaluate the efficacy and safety of isavuconazole capsules in diagnostic-driven treat-ment of hematologic malignancies with invasive aspergillus pneumonia in Chinese patients.Methods:The antifun-gal efficacy and safety of isavuconazole capsules as monotherapy were retrospectively analyzed from June 2022 to September 2023 in 28 patients with hematologic malignancies,who still had fever after broad-spectrum antibiotics and considered invasive aspergillus pneumonia with lung CT or fungal antigen detection.Patients were divided into four groups,group A(5 cases):invasive fungal infections under posaconazole prevention,group B(15 cases):voriconazole intolerance/ineffectiveness group,group C(5 cases):possible invasive mucormycosis group,group D(3 cases):amphotericin B or caspofungin intolerance/ineffectiveness group.Results:All the 28 patients(60.71％with acute leukemia)were immunodeficient.The baseline neutrophil count was 0.49(0.24,5.52)×109/L,and the average treatment duration was 14 days.The total effective rate after treatment was 82.14％(23/28).Three patients still had intermittent fever and no imaging improvement after treatment,1 patient died after disease pro-gression,1 patient was discharged automatically during treatment.There were no significant differences in aspar-tate aminotransferase,alanine aminotransferase,creatinine and Q-T interval among the four groups before and af-ter treatment(P＞0.05),among which 1 patient in group B had aspartate aminotransferase and alanine amin-otransferase reduced to normal after isavuconazole treatment,creatinine did not rise again in 2 patients after treat-ment,nausea occurred in 2 patients,diarrhea occurred in 1 patient.One patient in group D had aspartate amin-otransferase and alanine aminotransferase elevated slightly and no patient stopped taking the drug due to adverse e-vents.Conclusion:Immune deficiencies enhance the likelihood of invasive fungal disease in patients with malignant hematologic diseases.Lung CT can provide significant evidence.Isavuconazole capsules monotherapy is highly ef-fective and safety in failure of posaconazole prevention or voriconazole intolerance/ineffectiveness during the diag-nostic driving stage of aspergillosis pneumonia.
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