Asunto(s)
Enfermedades de la Córnea/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Mieloma Múltiple/complicaciones , Paraproteinemias/tratamiento farmacológico , Talidomida/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carmustina/administración & dosificación , Ciclofosfamida/administración & dosificación , Doxorrubicina/administración & dosificación , Humanos , Masculino , Melfalán/administración & dosificación , Persona de Mediana Edad , Mieloma Múltiple/tratamiento farmacológico , Agudeza VisualRESUMEN
Fluconazole is widely used as antifungal prophylaxis but it is ineffective against Aspergillus. Itraconazole has a broader spectrum of activity but the capsules give erratic bioavailability in neutropenic patients. We compared itraconazole oral solution (which has an improved pharmacokinetic profile) with fluconazole for antifungal prophylaxis. Adults with haematological malignancies receiving chemotherapy or bone marrow transplants were randomly allocated 5 mg/kg/d itraconazole (itra) solution (288 episodes) or 100 mg fluconazole suspension (flu) (293 episodes) from before the onset of neutropenia until neutrophil recovery or suspected fungal infection. Outcomes were assessed by independent reviewers unaware of the prophylaxis allocation. More proven systemic fungal infections occurred in flu (Aspergillus four, Candida tropicalis one, C. krusei one) than itra (C. albicans one) and more of these were fatal (four versus nil). This difference reached statistical significance when first study episodes were considered separately (six flu versus nil itra, P = 0.03). Significantly more deaths of presumed fungal origin occurred in flu than itra (seven versus nil, P = 0.024). There were significantly more cases of proven aspergillosis in flu than itra (six versus nil, P = 0.038, 5/6 cases were fatal) if those occurring outside the study period are included. Significantly more patients receiving flu required amphotericin B (58 v 39, P = 0.043) but this may have been affected by the fact that the study was not blinded. There were 11 proven mucosal candidal infections in flu and four in itra. Itraconazole solution and fluconazole provide effective prophylaxis against Candida but itraconazole affords greater protection against fatal aspergillosis.
Asunto(s)
Antifúngicos/uso terapéutico , Fluconazol/uso terapéutico , Neoplasias Hematológicas/complicaciones , Itraconazol/uso terapéutico , Micosis/prevención & control , Adolescente , Adulto , Anciano , Antineoplásicos Fitogénicos/uso terapéutico , Interacciones Farmacológicas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Micosis/complicaciones , Infecciones Oportunistas/complicaciones , Vincristina/uso terapéuticoRESUMEN
Over three years, three children presented with anaemia, reticulocytopenia, and marrow erythroblastopenia. A pronounced lymphocytosis was also evident in two of the marrow aspirates, with increased numbers of cells bearing the immunophenotype TdT+, CD10+ HLA DR+, and cytoplasmic mu +, and reported to be compatible with acute lymphoblastic leukaemia (ALL). The clinical course of the illness was fully compatible with transient erythroblastopenia of childhood (TEC), and all three children remained well one to four years after initial presentation. It is concluded that increased numbers of lymphoid cells with a common or pre-B ALL phenotype may be found in bone marrow aspirates of children with TEC, and should not be misdiagnosed as acute leukaemia.