ASSOCIATION THERAPY AS A PROGNOSTIC FACTOR IN DEEP FUNGAL INFECTION COMPLICATING ONCOHAEMATOLOGICAL DISEASES

A group of 31 oncohaemopathic patients (17 male, mean age 44 +/- 6 yea rs), diagnosed as having primary deep fungal infection involving the l ungs, were retrospectively evaluated. When infection was suspected on a clinical basis the major associated risks for death were the duratio n of bone marrow aplasia (12 +/- 7 versus 21 +/- 6 days, P < 0.001), i ncrease in white blood cells and, in particular, prolonged granulocyto penia (11 +/- 5 versus 24 +/- 8 days, P < 0.001) when survivors were c ompared with patients, who died. Our therapeutic empirical approach wa s based on the association of i.v. amphotericin B, 1 mg kg(-1) day(-1) , with oral 5-fluorocytosine (5-FC) 150 mg kg(-1) day(-1). Only 9 subj ects received combination therapy for more than 7 days. For majority o f them, oral 5-FC was interrupted because of altered compliance or sus tained liver damage. A chi(2) test for independent parameters showed ( P = 0.0021) a concentration of deaths among patients who received amph otericin B alone (15/ 22); none of the patients treated with amphoteri cin B + 5-FC (9 cases) died. Results generally suggest that a more fav ourable outcome was statistically associated with empirical antifungal combination therapy in deep fungal infection, although both treatment regimens showed effectiveness in terms of survival. Nevertheless the low 5-FC compliance and the small sample do not indicate the safe use of this drug in a large population.