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: 2.39). 07/2012; 59(1):21-6. DOI: 10.1002/pbc.23415
Source: PubMed


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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    • "Even with this large infectious burden, there is great variability in supportive care strategies used for pediatric AML across institutions [2]. Clinical trials are currently being conducted to address these uncertainties [3,4]. However, there are some common themes; most North American centers do not use routine anti-bacterial prophylaxis (other than for Pneumocystis jirovecii) and most use fluconazole as antifungal prophylaxis [2]. "
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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.
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    Drugs 03/2012; 72(5):685-704. DOI:10.2165/11599810-000000000-00000 · 4.34 Impact Factor
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