Efficacy of Caspofungin in Unclassified Invasive Fungal Infection Cases: A Retrospective Analysis of Patients with Hematological Malignancies in China

Abstract

BackgroundThe management of invasive fungal infection (IFI) is challenging in immunocompromised patients who do not fully satisfy the EORTC/MSG diagnostic criteria of proven or probable IFI. Our study assessed caspofungin efficacy in 582 Chinese patients with hematological malignancies exhibiting unclassified signs or symptoms of IFI.Material/MethodsThis retrospective study included caspofungin treatment outcomes of an unclassified group A (n=401) of patients without microbiological or biomarker results and group B (n=181) patients with positive microbiological or biomarker results. Factors that correlated with clinical outcomes were determined using univariate and multivariate analyses.ResultsCough (41.8%), expectoration (29.6%), and chest tightness (14.6%) were the most common clinical features, and changes in CT images (88.1%) were more frequently detected than in X-ray images (19.6%) in all patients. Favorable response rates for caspofungin as first-line treatment were 58.2% for group A and 56.3% for group B. Eastern Cooperative Oncology Group (ECOG) score, cardiovascular disease, hemoptysis, and absolute neutrophil count (ANC) <1000/mm3 before antifungal treatment without recovery were associated with unfavorable clinical outcome (P<0.05 for all). Cough and ANC recovery >1000/mm3 were significantly associated with favorable (complete or partial resolution) outcome.ConclusionsCaspofungin was effective for treating unclassified IFIs of immunocompromised patients. Cardiovascular disease, ECOG score, cough, and/or hemoptysis, as well as ANC count, represent a potential index for estimating response of unclassified IFI patients to caspofungin treatments.

Efficacy and safety of caspofungin for patients with hepatic insufficiency

“…In terms of efficacy, the overall effective rate (63%) when treating with caspofungin in patients with different Child–Pugh classifications was almost consistent with the effective rate (65%) reported by Xiaohui Zhang et al [ 12 ]. There was no difference in the efficacy of caspofungin in patients with different hepatic function grades, suggesting that even without dose reduction, grade B and C patients tolerated caspofungin not differently from grade A patients and had better treatment outcomes.…”

Clinical Characteristics of Transplant Recipients Infected with Talaromyces Marneffei: 2 Case Reports and a Literature Review

“…This suggests that clinicians should monitor the tacrolimus concentration and should adjust the dose of immunosuppressive drugs in a timely manner if the patient requires the use of azole antifungal drugs.In both case reports in this article, antifungal treatment with caspofungin was used.Caspofungin was effective for treating unclassified invasive fungal infection of immunocompromised patients. 40 This may explain why both patients were treated with caspofungin.In a study by Jing Zhang, it can be found that, compared with amphotericin B, itraconazole, and voriconazole, caspofungin showed relatively higher MICs (minimum inhibitory concentrations) among mold and yeast forms. 41 This suggests that caspofungin is less effective in patients with TM infection.…”