Clinical features | Biology results | Antimicrobial therapy | ||
---|---|---|---|---|
D-19 | Start of chemotherapy | Neutropenia | ||
D0 | Febrile neutropenia | High level of CRP and PCT | Antibiotherapy introduction | Ceftriaxone 100 mg/kg/d |
D3 | Persistence of fever | Rising of CRP and PCT rates | Antibiotherapy switch | Tazobactam Piperacillin 400 mg/kg/d Amikacine |
D6 | Persistence of fever | Adding antifungal therapy | Caspofungin 70 mg/m2 day 1, then 50 mg/m2/d | |
D10 | Abnormal chest CT scan and abdominal ultra-sound | Antifungal combined therapy | Adding voriconazole 9 mg/kg bid day 1, then 8 mg/kg bid IV | |
D16 | Negative BAL | Withdrawal Antibiotherapy and caspofungin | ||
D21 | Positive Fundoscopy | Voriconazole intravitreal injection 50 μg/ml | ||
D24 | Abnormal brain MRI Initiation of TDM on D27 | Switch antifungal therapy | Isavuconazole 70 mg every 8 h for 48 h, then 70 mg/d IV | |
D31 | Isavuconazole 90 mg/d IV | |||
D37 | Antifungal combined therapy | Isavuconazole 90 mg bid IV L-AmB 10 mg/kg/d | ||
D39 | Fever resolution | |||
D58 | Isavuconazole 100 mg bid p.o | |||
D63 | TPL steady state | |||
M6 | Regression of lesions on imagery | |||
M8 | Leukaemia relapse | Withdrawal isavuconazole | L-AmB 7 mg/kg/d | |
M12 | Complete remission | Switch antifungal therapy | Isavuconazole 50 mg bid p.o | |
M16 | Regression of lesions on imagery |