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Antifungal Therapy in Pediatric Acute Lymphoblastic Leukemia: A Single-center Experience. J Pediatr Hematol Oncol 2022; 44:e653-e657. [PMID: 34486550 DOI: 10.1097/mph.0000000000002297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/10/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Invasive fungal infections (IFIs) are significant causes of morbidity and mortality in leukemia patients. This study investigated antifungal treatment and prophylaxis features according to leukemia risk groups and treatment phases in pediatric acute lymphoblastic leukemia (ALL) patients who received Berlin-Frankfurt-Munster-based protocols. MATERIALS AND METHODS We retrospectively examined ALL patients' data between the ages of 1 and 18 and treated them with Berlin-Frankfurt-Munster-ALL protocols between June 2013 and December 2016. RESULTS A total of 446 febrile neutropenic attacks in 85 children were evaluated. Seventy-two patients received antifungals in 151 infection attacks, while 13 patients did not receive any antifungal treatment during chemotherapy. Empirical, preemptive, or proven treatments were given to 74.8%, 21.2%, and 4% of patients, respectively. The frequency of antifungal therapy increased linearly and significantly from the standard-risk group to the intermediate-risk (IR) group, high-risk (HR) group, and relapsed group. IR patients needed more antifungal therapy while receiving induction, whereas HR patients needed more throughout the induction and HR consolidation blocks than other phases. During induction, IR patients received antifungal therapy similar to HR patients' treatment in the induction and HR consolidation blocks. CONCLUSIONS Antifungal therapy requirements increased as the severity and intensity of chemotherapy increased for all leukemia risk groups. The requirement of antifungal therapy for IR patients receiving induction was similar to that of HR patients; further studies are needed to evaluate the potential advantages of using primary antifungal prophylaxis in IR patients.
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Maquera-Afaray J, Luna-Vilchez M, Salazar-Mesones B, Portillo-Alvarez D, Uribe-Ramirez L, Taipe-Sedano G, Santillán-Salas C, López JW. Antifungal Prophylaxis With Posaconazole in Immunocompromised Children Younger Than 13 Years. J Pediatr Pharmacol Ther 2022; 27:57-62. [PMID: 35002560 DOI: 10.5863/1551-6776-27.1.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/03/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Prophylaxis with posaconazole (PP) is effective in the prevention of invasive fungal infections in immunocompromised adult patients. However, evaluation of its effectiveness and safety in children is limited. The aim of the study was to describe the use of posaconazole as antifungal prophylaxis in children. METHODS We reviewed the medical records of immunocompromised patients younger than 13 years with hematologic diseases and post hematopoietic stem cell transplant (HSCT) who received antifungal PP at the Instituto Nacional de Salud del Niño San Borja (INSN-SB) in Lima, Peru, from January 2014 to December 2018. RESULTS Fifty-six courses of PP were identified in 47 patients with a median age of 7.5 years (IQR, 4-10), 51.6% (n = 24) of whom were female. The main underlying medical conditions were aplastic anemia (n = 19, 33.9%), acute lymphoblastic leukemia (n = 18, 32.1%), acute myeloid leukemia (n = 14, 25.0%), and 34.1% had undergone HSCT. The median dose of posaconazole was 13.62 mg/kg/day (IQR, 12.0-16.8), and the median duration of PP was 24 days (IQR, 16-82). Gastrointestinal symptoms included abdominal pain (17.9%), nausea (16.1%), diarrhea (7.1%), and vomiting (3.6%). Elevated alanine aminotransferase and aspartate aminotransferase levels were observed in 9/35 patients (25.7%) and 10/51 (19.6%) patients, respectively. Five cases of breakthrough fungal infection were identified (8.9%). CONCLUSIONS Patients younger than 13 years who received PP showed an increase in transaminase values, and the development of breakthrough fungal infections.
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Affiliation(s)
- Julio Maquera-Afaray
- Unidad de Atención Integral Especializada (JM-A, ML-V, BS-M, DP-A, LU-R, GT-S, CS-S, JWL), Instituto Nacional de Salud del Niño San Borja, Lima, Perú.,Facultad de Ciencias de la Salud (JM-A), Universidad Privada de Tacna, Tacna, Perú
| | - Medalit Luna-Vilchez
- Unidad de Atención Integral Especializada (JM-A, ML-V, BS-M, DP-A, LU-R, GT-S, CS-S, JWL), Instituto Nacional de Salud del Niño San Borja, Lima, Perú
| | - Blanca Salazar-Mesones
- Unidad de Atención Integral Especializada (JM-A, ML-V, BS-M, DP-A, LU-R, GT-S, CS-S, JWL), Instituto Nacional de Salud del Niño San Borja, Lima, Perú
| | - Diana Portillo-Alvarez
- Unidad de Atención Integral Especializada (JM-A, ML-V, BS-M, DP-A, LU-R, GT-S, CS-S, JWL), Instituto Nacional de Salud del Niño San Borja, Lima, Perú
| | - Luis Uribe-Ramirez
- Unidad de Atención Integral Especializada (JM-A, ML-V, BS-M, DP-A, LU-R, GT-S, CS-S, JWL), Instituto Nacional de Salud del Niño San Borja, Lima, Perú
| | - Graciela Taipe-Sedano
- Unidad de Atención Integral Especializada (JM-A, ML-V, BS-M, DP-A, LU-R, GT-S, CS-S, JWL), Instituto Nacional de Salud del Niño San Borja, Lima, Perú
| | - Carlos Santillán-Salas
- Unidad de Atención Integral Especializada (JM-A, ML-V, BS-M, DP-A, LU-R, GT-S, CS-S, JWL), Instituto Nacional de Salud del Niño San Borja, Lima, Perú
| | - José W López
- Unidad de Atención Integral Especializada (JM-A, ML-V, BS-M, DP-A, LU-R, GT-S, CS-S, JWL), Instituto Nacional de Salud del Niño San Borja, Lima, Perú.,Facultad de Ciencias de la Salud (JWL), Universidad Científica del Sur, Lima, Perú
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Castagnola E, Palmisani E, Mesini A, Saffioti C, Micalizzi C, Dufour C. Comment on: Invasive fungal infections in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2020; 67:e28035. [PMID: 31599489 DOI: 10.1002/pbc.28035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Elio Castagnola
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy
| | - Elena Palmisani
- Hematology Unit, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy
| | - Alessio Mesini
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy
| | - Carolina Saffioti
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy
| | | | - Carlo Dufour
- Hematology Unity, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy
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Mesini A, Faraci M, Giardino S, Ricci E, Barco S, Cangemi G, Lanino E, Castagnola E. Alternate-day dosing of posaconazole tablets in children leads to efficient plasma levels. Eur J Haematol 2018. [DOI: 10.1111/ejh.13063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Alessio Mesini
- Infectious Diseases Division; DiSSal; University of Genova; Genoa Italy
| | - Maura Faraci
- Istituto Giannina Gaslini; Children's Hospital; Genoa Italy
| | | | | | | | | | - Edoardo Lanino
- Istituto Giannina Gaslini; Children's Hospital; Genoa Italy
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