Medications for the secondary prevention of ischaemic heart disease and heart failure are underutilized in dialysis patients

Ranchord, Anil; Harding, S.; Pidgeon, G. B.

doi:10.1111/j.1445-5994.2008.01649.x

Cited by 8 publications

(6 citation statements)

References 14 publications

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“… 10 Although there is a strong consensus that HiDAC regimen is a risk factor for IFI, and antifungal prophylaxis is warranted and recommended by clinical guidelines, using antifungal prophylaxis after HiDAC as consolidation treatment for AML in remission remains controversial. 11 – 14 More recently, a retrospective analysis in 27 patients receiving 76 cycles of HiDAC demonstrated that HiDAC as consolidation therapy was associated with low-risk of fungal infection and the incidence of documented IFI, empirical intravenous antifungal use and duration of antibiotic use were not increased. 15 …”

Section: Introductionmentioning

confidence: 99%

Does High-Dose Cytarabine Cause More Fungal Infection in Patients With Acute Myeloid Leukemia Undergoing Consolidation Therapy

Wang

Sun

et al. 2016

Medicine

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Invasive fungal infection (IFI) remains as a significant cause of morbidity and mortality in patients with acute myelogenous leukemia (AML). Here, we report the subgroup analysis of China Assessment of Antifungal Therapy in Haematological Disease (CAESAR) study to evaluate the risk of IFI in patients with AML in 1st remission receiving high-dose cytarabine (HiDAC) as consolidation. A total of 638 patients with AML in 1st complete remission were selected from the database. Among them, 130 patients received HiDAC alone with total dose of 2–3 g/m2 × 6 while 508 patients received multiple-agent combination chemotherapy (multiagent chemo group). The patients’ characteristics were generally not different but more patients in HiDAC group had peripherally inserted central catheter (61.5% vs 44.5%, P = 0.002). The median duration of neutropenia was 8.0 days in both HiDAC (2–20) and multiagent chemo group (2–28). Number of patients with prolonged neutropenia (>14 days) tended to be more in multiagent chemo group but not significant different (16.3% vs 8.8%, respectively). There was no significant difference between 2 groups in persistent neutropenic fever (40.8% vs 33.1%), antifungal treatment (11.5% vs 11.4%), and incidence of proven/probable IFI (4 probable in HiDAC vs 1 proven/4 probable in multiagent chemo, P = 0.35) or possible IFI. As to the clinical outcome in terms of duration of hospitalization and death in remission, there was a trend of shorter duration of hospitalization in HiDAC (19 days, 3–70) compare to multiagent chemo group (21 days, 1–367, P = 0.057) while no death documented in HiDAC group and only 2 patients died in the multiagent chemo group (0.4%). As to risk factors associated with IFI in all 638 patients, there was a trend of more IFI in patients with severe neutropenia (3.0%, P = 0.089) and previous history of IFI (3.85%, P = 0.086) while the antifungal prophylaxis was not associated significantly reduced IFI. Overall, our data support the perception that HiDAC alone as consolidation in first remission AML patients was well tolerated and not associated with increased hematological toxicity and IFI than conventional combination chemotherapy. Antifungal prophylaxis may not necessary except for patients with previous history of IFI.

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Section: Introductionmentioning

confidence: 99%

Does High-Dose Cytarabine Cause More Fungal Infection in Patients With Acute Myeloid Leukemia Undergoing Consolidation Therapy

Wang

Sun

et al. 2016

Medicine

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“…3 In patients deemed at high risk of IFD without an approved indication, antifungal prophylaxis was used at the discretion of the treating clinician in consultation with the infectious diseases department. In patients suspected of having an IFD because of clinical symptoms or persistent fever, the diagnostic work-up typically included imaging with high-resolution computed tomography (CT) of the chest and sinuses (if symptoms) or fluorine-18 fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT), followed by directed tissue sampling for microscopy and fungal culture.…”

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confidence: 99%

Epidemiology of invasive fungal disease in lymphoproliferative disorders

et al. 2015

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ous oral chemotherapy in myeloma cohort, IFD rate per 10,000 treatment days not provided. © F e r r a t a S t o r t i F o u n d a t i o nhaematologica 2015; 100:e463 Table 2. Characteristics of patients with lymphoproliferative disorders with invasive fungal disease (2009)(2010)(2011) LETTERS TO THE EDITOR © F e r r a t a S t o r t i F o u n d a t i o nFluconazole and mold-active antifungal prophylaxis were administered to 287/773 (37.1%) and 38/773 (4.9%) patients, respectively. Patients with precursor lymphoid neoplasms had the highest prevalence of IFD (5/17; 29.4%, 95% CI 9.5-68.6%), followed by patients with mature B-cell neoplasms-CLL/SLL (4/51; 7.8%, 95% CI 2.1-20.1%), DLBCL (8/186; 4.3%, 95% CI 1.9-8.5%) and plasma cell neoplasms (7/251; 2.8%, 95% CI 1.1-5.7%). IFD events per treatment days demonstrated a similarly larger relative burden of disease in patients with precursor lymphoid neoplasms (10.7 IFD per 10,000 treatment days) ( Table 1). Mold-active antifungal prophylaxis was used in 52.9% of patients with precursor lymphoid neoplasms. Of the five patients with precursor lymphoid neoplasms who developed IFD, three had received fluconazole prophylaxis, one had received posaconazole prophylaxis and one received no antifungal prophylaxis. IFD was observed to occur at different treatment stages of disease, and these are summarized in Table 2.Aspergillus species was the most frequently identified fungal pathogen (13 cases) (cultured in 7 cases; detected on PCR in 8 cases). Other fungal pathogens, in order of reducing frequency included Candida (5 cases), Scedosporium (1 case), Scopulariopsis (1 case) and Cryptococcus (1 case) species. The pulmonary system (19 cases) was the most common site of IFD, followed by blood (5 cases), sinus (2 cases), soft tissue/viscera (2 cases) and central nervous system (1 case). Of the 29 patients treated for IFD, 12 (41.4%) required admission to the intensive care unit and 30-day all-cause mortality was 31.0% (9/29).IFD is an important and potentially modifiable cause of morbidity and mortality in patients with lymphoproliferative disorders receiving chemotherapy. Few studies have described the epidemiology and treatment outcome of IFD in these patients and none has incorporated all of the current diagnostic strategies available (e.g. Aspergillus PCR, galactomannan and FDG PET/CT diagnostics). Our study identified an overall IFD prevalence of 3.8% with cases occurring in all disease subsets except mature Tand NK-cell lymphoma. The prevalence of IFD was highest in patients with precursor lymphoid neoplasms (29.4%). This occurred despite 52.9% of patients receiving mold-active prophylaxis. This finding is consistent with a 28% incidence reported at another Australian center 8 and may be attributed to the increasing intensity of induction chemotherapy protocols for lymphoblastic haematologica 2015; 100:e465 R: rituximab; CVP:cyclophosphamide/vincristine/prednisolone; bortez: bortezomib; dex: dexamethasone; thal: thalidomide; len: lenalidomide; bleomycin, vincristine, etopo...

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“…6 Within this schema, those ranked at highest risk of IFD include matched unrelated or mismatched allograft recipients, umbilical cord donor graft recipients, allogeneic HSCT recipients on immunosuppression for acute grade 2-4 or chronic extensive GVHD, and patients with acute myeloid leukaemia (AML) receiving cytarabine-based chemotherapy regimens for remission induction or re-induction. 7 Those AML patients receiving intensive consolidation treatment were also considered at high risk for IFD.…”

Section: Discussionmentioning

confidence: 99%

Survey of antifungal prophylaxis and fungal diagnostic tests employed in malignant haematology and haemopoietic stem cell transplantation (HSCT) inAustralia andNewZealand

Hal

Gilroy

Morrissey

et al. 2014

Internal Medicine Journal

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This article reports the findings of a survey developed to assess the current use of antifungal prophylaxis among haematology and infectious disease clinicians across Australia and New Zealand, and their alignment with existing consensus guidelines for the use of antifungal agents in the haematology/oncology setting (published 2008). Surveyed clinicians largely followed the current recommendations for prophylaxis in the setting of induction chemotherapy for acute myeloid leukaemia, as well as autologous and low-risk allogeneic haemopoietic stem cell transplantation (HSCT). In keeping with guideline recommendations, posaconazole was the agent used by most centres for high-risk allogeneic HSCT. However, its routine continuation for 75-100 days posttransplantation without de-escalation suggested use beyond those indications described in the 2008 guidelines, namely pre-engraftment neutropenia and graft-versus-host disease. Variations in practice were observed in other settings, such as acute lymphoblastic leukaemia and myelodysplastic syndrome, reflecting the general lack of evidence for antifungal prophylaxis in these patient populations and changing perceptions of risk. With regard to the availability of testing in cases of suspected breakthrough IFD, 40% of centres did not have access to investigative bronchoscopy within 48 h of referral, and results of Aspergillus galactomannan (GM), fungal polymerase chain reaction and therapeutic drug monitoring (TDM) were not available within 48 h in 83%, 90% and 85% of centres respectively. The survey's findings will influence the recommendations provided in the updated 2014 consensus guidelines for the use of antifungal agents in the haematology/oncology setting.

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Medications for the secondary prevention of ischaemic heart disease and heart failure are underutilized in dialysis patients

Cited by 8 publications

References 14 publications

Does High-Dose Cytarabine Cause More Fungal Infection in Patients With Acute Myeloid Leukemia Undergoing Consolidation Therapy

Does High-Dose Cytarabine Cause More Fungal Infection in Patients With Acute Myeloid Leukemia Undergoing Consolidation Therapy

Epidemiology of invasive fungal disease in lymphoproliferative disorders

Survey of antifungal prophylaxis and fungal diagnostic tests employed in malignant haematology and haemopoietic stem cell transplantation (HSCT) inAustralia andNewZealand

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