Surveillance of the serum Candida antigen titer for initiation of antifungal therapy after postremission chemotherapy in patients with acute leukemia

The early diagnostic efficacy of serial Candida antigen detection by the as say kit CAND-TEC (a latex particle agglutination test) was evaluated in 12 episodes in 10 patients with acute leukemia after postremission chemotherap y. To determine the timing to initiate antifungal chemotherapy, we performe d the CAND-TEC assay serially in each patient. When the patients revealed f ebrile neutropenia after antileukemic chemotherapy and the Candida antigen titer was increased compared to that measured before the antileukemic chemo therapy (even if the increased titer was at a lower level, eg, from negativ e to 1:1 positive or from 1:1 to 1:2), azole antifungal agents (fluconazole or miconazole) were administered intravenously. In 9 (81.8%) of the 11 eva luable cases, the antifungal chemotherapy was effective and the titers decr eased to less than or equal to the previous titers in all cases. Zn 2 cases , the antifungal chemotherapy was not effective, and the titers did not dec rease. These results suggest that serial Candida antigen detection provides a useful method in the early diagnosis of invasive candidiasis in febrile neutropenia and in determining the timing of the initiation of early antifu ngal chemotherapy. This method might also be useful in preventing the exces s use of antifungal agents; thus preventing the proliferation of azole-resi stant Candida infection. Int J Hematol. 2000;71:266-272 (C) 2000 The Japane se Society of Hematology.