Caspofungin Treatment for Pulmonary Invasive Fungal Disease in Hematology Patients: A Retrospective Study in a Clinical Practice Setting in China

Abstract

Purpose: Invasive fungal disease (IFD) is a serious complication in patients with hematologic malignancies. Caspofungin is the first approved inhibitor of fungal β-1,3-glucan synthesis. The aim of the present study was to evaluate the effectiveness of caspofungin in the treatment of IFD in patients with hematologic malignancies.

Methods: In this retrospective study, data from the electronic medical records of 1118 inpatients who were admitted to 10 hospitals in China between 2013 and 2014 were analyzed. Inclusion criteria were hematologic disorder and IFD diagnosed during the hospitalization, based on clinical manifestations or evidence of pulmonary invasion, as well as caspofungin treatment for at least 7 days. The primary end point was the favorable response rate at the end of caspofungin as initial therapy for proven/probable/possible pulmonary IFD. The secondary end point was the survival rate after the completion of the caspofungin treatments.

Findings: A total of 704 patients were included, of whom 122 had IFD classified as probable/possible and 582 had unclassified IFD. The most frequent hematologic diseases were acute myeloid leukemia (42.8%), followed by acute lymphatic leukemia (18.8%), non-Hodgkin lymphoma (8.8%), aplastic anemia (7.1%), and others (22.5%). The rates of favorable caspofungin response were 57.2% in all patients, 58.2% in the probable/possible IFD group, and 57.0% in the unclassified IFD group. Caspofungin as initial monotherapy led to a favorable response rate of 62.2% in the probable/possible IFD group. Uni- and multivariate analyses revealed that not recovering from neutropenia during antifungal treatment, and advanced age, were significant factors for unfavorable outcomes. The overall IFD-related mortality rate was 4.1%.

Implications: The results of our study show that caspofungin treatment of IFD in hematology patients was reasonable, with an overall rate of favorable response of 57.2% with each caspofungin treatment strategy.

Keywords: caspofungin; echinocandin hematological disorders; invasive fungal infection; lymphatic leukemia.