Antifungal prophylaxis in pediatric hematology/oncology: New choices & new data

Division of Pediatric Blood & Marrow Transplant, Department of Pediatrics, University of California San Francisco, San Francisco, California 94143-1278, USA.
Pediatric Blood & Cancer (Impact Factor: 2.56). 07/2012; 59(1):21-6. DOI: 10.1002/pbc.23415
Source: PubMed

ABSTRACT A severe complication of the treatment of pediatric cancers is the development of an invasive fungal infection (IFI). The data to support antifungal prophylaxis in pediatric oncology patients derive primarily from adult patients, and thus the optimal agent to utilize is not clear. Fluconazole has been a standard option, but agents with antimold activity are now available, each with limitations. Pediatric dosing for voriconazole and posaconazole is uncertain and multiple drug interactions exist. The echinocandins are well-tolerated, but only available in intravenous form. Ultimately, studies demonstrating biologic risk factors for the development of IFI may lead to personalized prophylactic strategies.

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    ABSTRACT: Background It is not known whether children with acute promyelocytic leukemia (APL) have an infection risk similar to non- APL acute myeloid leukemia. The objective was to describe infectious risk in children with newly diagnosed APL and to describe factors associated with these infections. Methods We conducted a retrospective, population-based cohort study that included children ≤ 18 years of age with de novo APL treated at 15 Canadian centers. Thirty-three children with APL were included; 78.8% were treated with APL -specific protocols. Results Bacterial sterile site infection occurred in 12 (36.4%) and fungal sterile site infection occurred in 2 (6.1%) children. Of the 127 chemotherapy courses, 101 (79.5%) were classified as intensive and among these, the proportion in which a sterile site microbiologically documented infection occurred was 14/101 (13.9%). There was one infection-related death. Conclusions One third of children with APL experienced at least one sterile site bacterial infection throughout treatment and 14% of intensive chemotherapy courses were associated with a microbiologically documented sterile site infection. Infection rates in pediatric APL may be lower compared to non- APL acute myeloid leukemia although these children may still benefit from aggressive supportive care during intensive chemotherapy.
    BMC Cancer 06/2013; 13(1):276. DOI:10.1186/1471-2407-13-276 · 3.32 Impact Factor
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    ABSTRACT: Infections in children and adolescents with cancer are a significant cause of morbidity and mortality, especially in those receiving chemotherapy who are neutropenic and/or immunocompromised. The aim of this article is to review existing evidence in order to provide a practice recommendation to prevent or minimize infections in neutropenic and/or immunocompromised patients receiving chemotherapy and/or stem cell transplant. Systematic reviews were undertaken and research was graded according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. A variety of interventions are implemented to reduce infections in the neutropenic and/or immunocompromised population; however, few are supported by research evidence. Existing literature should continue to be reviewed to further identify interventions that can influence positive patient outcomes and provide opportunities for individuals in the medical field to work together to improve clinical care.
    Journal of Pediatric Oncology Nursing 06/2014; 31(4):200-210. DOI:10.1177/1043454214532027 · 0.87 Impact Factor
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    ABSTRACT: Introduction Invasive fungal infections (IFI) are serious complications of chemotherapy-induced immunosuppression of children treated in hematology/oncology pediatric unit. The incidence of those complications is known to be particularly high among children treated for acute myeloid leukemia (AML). Methods In this retrospective and multicenter study, all children with an invasive fungal infection (defined according to the EORTC/MSG criteria) during their chemotherapy treatment according to ELAM 02 protocol from 2005 to 2011 were included. Patients were treated in Hematology/Oncology centers of the SFCE (Société française de lutte contre les cancers et leucémies de l’enfant et de l’adolescent). No prophylactic antifungal therapy was recommended. Results Twenty-six cases of IFI occurred (incidence of 6.7%). The median age was 12 years. There were 15 aspergillosis, nine candidiasis and two mucormycosis. Twelve IFI were defined as proven, six probable and eight possible. Most of them occurred during the intensive phase of treatment and located in the lung. In a comparative analysis with the non-IFI group, no risk factor was demonstrated. All children were treated by new antifungal drugs and the therapeutic strategies were studied. With a median follow-up of 34 months, 10 patients died; among them, two deaths were directly attributable to the IFI. There was no significant difference concerning overall survival and event-free survival between the group with and without IFI. Conclusion Recommendations for the management of IFI in pediatric oncology patients have been published but prospective and multicenter pediatrics studies are still necessary to improve preventive strategies, early diagnosis and treatment of IFI in this population.
    12/2013; 1(s 3–4):130–138. DOI:10.1016/j.oncohp.2013.10.005