scholarly journals Clinical Experience of Antifungal Combination Therapy for Invasive Fungal Infections in Pediatric Hematological Malignancy Patients

2021 ◽  
Author(s):  
Saliha Kanık Yüksek ◽  
Aslınur Özkaya Parlakay ◽  
Belgin Gülhan ◽  
Neşe Yaralı ◽  
Namık Yaşar Özbek ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Fungal Infections ◽  
Lymphoblastic Leukemia ◽  
Total Mortality ◽  
Complete Response ◽  
Hematologic Malignancies ◽  
Invasive Fungal Infections ◽  
Attributable Mortality ◽  
Combination Regimen ◽  
Pediatric Leukemia

Background: The role of combination regimens in the treatment of invasive fungal infections (IFI) in patients with hematologic malignancies remains unclear. This study was aimed to demonstrate experience data about combined antifungal therapy (CAT) in pediatric IFI patients with haematological malignancies. Methods: Between January 2014 and December 2017, a total of 33 IFI episodes in 28 patients with hematological malignancies were analyzed retrospectively. Results: Of the patients (19 with acute lymphoblastic leukemia, and 9 with acute myeloblastic leukemia), 21 (75%) had leukemia relapse and 7 (25%) had remission. IFI was classified as possible in 26 (78.8%) episodes, probable in 5 (15.1%) episodes, and proven in 2 (6.1%) episodes. LamB (%50) was the most preferred agent in monotherapy. Mean duration of monotherapy was 12.84 ± 4.28 (5-24) days. LamB plus voriconazole (54.5%) were the most common combination preference in CAT. Mean duration of CAT was 42.36 ± 36.4 days, and unchanged according to combination regimen type (p = 0.571). Total mortality rate and IFI attributable mortality rate were 60.7% vs 76.5%. Mortality rate was significantly higher in patients with relapse (p = 0.006). Complete response was obtained in 81.8% of surviving patients. Duration of neutropenia and CAT, and recovery time were not found statistically different in the episodes with/without death and according to relapse or remission status. Side effects due to CAT use were observed quite low level. Conclusion: CAT has been found to be safe in IFI episodes of pediatric leukemia. The result will contribute to the data about combined antifungal use in daily clinical practice in pediatric haematological patients with IFI.

scholarly journals Invasive fungal infections in a pediatric hematology-oncology department: A 16-year retrospective study

2020 ◽  
Author(s):  
Nikoleta Kazakou ◽  
Timoleon-Achilleas Vyzantiadis ◽  
Anastasia Gambeta ◽  
Eleni Vasileiou ◽  
Eleni Tsotridou ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Fungal Infections ◽  
Lymphoblastic Leukemia ◽  
Patient Characteristics ◽  
Hematologic Malignancies ◽  
Incidence Rates ◽  
Invasive Fungal Infections ◽  
Antifungal Treatment ◽  
Pediatric Hematology ◽  
Non Hodgkin Lymphoma

Background and Purpose: Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in immunocompromised children. The purpose of our study was to evaluate the incidence of IFIs in pediatric patients with underlying hematologic malignancies and determine the patient characteristics, predisposing factors, diagnosis, treatment efficacy, and outcome of IFIs. Materials and Methods: For the purpose of the study, a retrospective analysis was performed on cases with proven and probable fungal infections from January 2001 to December 2016 (16 years). Results: During this period, 297 children with hematologic malignancies were admitted to the 2nd Pediatric Department of Aristotle University of Thessaloniki, Greece, and 24 cases of IFIs were registered. The most common underlying diseases were acute lymphoblastic leukemia (ALL; n=19, 79%), followed by acute myeloid leukemia (AML; n=4, 17%) and non-Hodgkin lymphoma (NHL; n=1, 4%). The crude incidence rates of IFIs in ALL, AML, and NHL were 10.5%, 18.2%, and 2.8% respectively. Based on the results, 25% (n=6) and 75% (n=18) of the patients were diagnosed as proven and probable IFI cases, respectively. The lung was the most common site of involvement in 16 (66.7%) cases. Furthermore, Aspergillus and Candida species represented 58.3% and 29.1% of the identified species, respectively. Regarding antifungal treatment, liposomal amphotericin B was the most commonly prescribed therapeutic agent (n=21), followed by voriconazole (n=9), caspofungin (n=3), posaconazole (n=3), micafungin (n=1), and fluconazole (n=1). In addition, 12 children received combined antifungal treatment. The crude mortality rate was obtained as 33.3%.  Conclusion: As the findings of the present study indicated, despite the progress in the diagnosis and treatment of IFIs with the use of new antifungal agents, the mortality rate of these infections still remains high. 

scholarly journals Deferiprone as adjunctive treatment for patients with invasive mucormycosis: A retrospective case series

2018 ◽  
Vol 10 (2) ◽  
Author(s):  
Maria N. Chitasombat ◽  
Pimjai Niparuck
Keyword(s):  
Mortality Rate ◽  
Treatment Strategies ◽  
Case Series ◽  
Hematologic Malignancies ◽  
Adjunctive Treatment ◽  
Combination Regimen ◽  
Retrospective Case ◽  
Day Range

Mucormycosis is a life-threatening disease requiring multimodal treatment with antifungals and surgery. The mortality rate remains high, prompting consideration of alternative treatment strategies. Deferiprone has in vitro activity against Mucorales, but its efficacy has never been evaluated in humans. Here, we retrospectively analyzed patients with confirmed mucormycosis who received deferiprone from 2011 to 2017. Five patients had hematologic malignancies and one was diabetic. The sites of infection included sinus-orbit-cerebral (67%), lung (17%), and disseminated infection (17%). Surgery was performed in 83% of cases and achieved local control for 33% of patients. A combination regimen of polyenes plus echinocandins was administered with stepdown treatment using posaconazole. The median duration of antifungal treatment was 86 days (range: 46-435 days) days. Deferiprone was given as adjunctive treatment with a median dose and duration of 100 mg/kd/day (range: 86.2-100 mg/kg/day) and 25 days (range: 15-215 days), respectively. Overall, deferiprone was well-tolerated. Successful outcomes were observed at 12-week follow-up for 67% of patients. The mortality rate at 180- day follow-up was 50%. Adjunctive therapy with deferiprone showed safety and tolerability.

Evaluating a voriconazole dose modification guideline to optimize dosing in patients with hematologic malignancies

2018 ◽  
Vol 25 (6) ◽  
pp. 1305-1311 ◽  
Author(s):  
Sarah Perreault ◽  
Dayna McManus ◽  
Anthony Anderson ◽  
Tiffany Lin ◽  
Michael Ruggero ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Therapeutic Range ◽  
Dose Adjustment ◽  
Fungal Infections ◽  
Hematologic Malignancies ◽  
Primary Objective ◽  
Invasive Fungal Infections ◽  
Patient Specific ◽  
Dose Modification ◽  
Number Of Patients

Background Voriconazole is an azole antifungal utilized for prophylaxis and treatment of invasive fungal infections in hematologic patients. Previous studies have revealed decreased efficacy and increased toxicity with subtherapeutic <1 mcg/mL and supratherapeutic > 4 mcg/mL levels. A voriconazole dose modification guideline was introduced in July 2014 based on a retrospective analysis. Objective The primary objective was to evaluate the voriconazole dose modification guideline. Secondary objectives were to identify patient-specific characteristics that contribute to inadequate levels, adverse effects, and breakthrough invasive fungal infections. Methods This prospective study included 128 patients with 250 admissions who received voriconazole from July 2014 to February 2016. Eligible adult patients receiving voriconazole for prophylaxis or treatment with at least one trough level, drawn appropriately, were included. Demographics, adverse effects, and breakthrough invasive fungal infections were documented. Results Voriconazole use was categorized as: new start, new start with loading dose, or continuation of home therapy. The median initial levels were 1.5, 3.5, and 1.7 mcg/mL with 62% (73/119), 55% (6/11), and 60% (72/120) within the therapeutic range, respectively. Using the voriconazole dose modification guideline, 80% were within goal by the second dose adjustment. Age ≤ 30 and BMI ≤ 25 kg/m2 had higher rates of subtherapeutic levels in the new start cohorts ( p = 0.024 and p = 0.009). Approximately 7.6% of patients experienced an adverse effect with neurologic/psychological being the most common. A total of 8.5% of patients had a possible, probable or proven breakthrough invasive fungal infections while on voriconazole. Conclusion Using the voriconazole dose modification guideline, the number of patients that reached therapeutic range improved from 36% to 80% by the second dose adjustment ( p = 0.007). This voriconazole dose modification guideline can be utilized to help dose and adjust voriconazole in order to achieve therapeutic levels.

scholarly journals 113 Invasive fungal infections among pediatric patients with hematologic malignancies at KFSH&RC/KFCCC&R

2006 ◽  
Vol 10 ◽  
pp. S63
Author(s):  
I. Bin-Hussain ◽  
F. Al Kordy ◽  
R. Serhan ◽  
A. Al Ahmari ◽  
A. Belgaumi ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Fungal Infections ◽  
Hematologic Malignancies ◽  
Invasive Fungal Infections

scholarly journals Polymerase chain reaction screening for fungemia and/or invasive fungal infections in patients with hematologic malignancies

2006 ◽  
Vol 14 (5) ◽  
pp. 469-474 ◽  
Author(s):  
Patrícia Ribeiro ◽  
Fátima Costa ◽  
Alexandra Monteiro ◽  
Joana Caldas ◽  
Madalena Silva ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Fungal Infections ◽  
Hematologic Malignancies ◽  
Invasive Fungal Infections ◽  
Chain Reaction ◽  
Polymerase Chain

scholarly journals Influence of antifungal prophylaxis on the occurrence of fungal infections in patients undergoing allogeneic transplantation

2021 ◽  
Vol 2 (2) ◽  
pp. 92-98
Author(s):  
Jelena Cakić ◽  
Irena Đunić
Keyword(s):  
Fungal Infections ◽  
Lymphoblastic Leukemia ◽  
Oral Candidiasis ◽  
Invasive Pulmonary Aspergillosis ◽  
Allogeneic Transplantation ◽  
Hematologic Malignancies ◽  
Antifungal Prophylaxis ◽  
Candida Spp ◽  
Medical Histories ◽  
The Impact

Introduction: Patients with hematologic malignancies, such as acute myeloid leukemia and acute lymphoblastic leukemia (AML/ALL), myelodysplastic syndrome (MDS), and those undergoing allergenic stem cell transplantation (alloSCT) are at the highest risk of invasive fungal infections (IFI). The most common causative agents are Candida spp. and Aspergillus spp. Among the strategies for preventing IFIs is the adequate implementation of antifungal prophylaxis recommended by the NCCN (National Comprehensive Cancer Network). Aim: The aim of the study was to analyze the occurrence of IFIs in these patients, as well as to analyze the impact and importance of timely antifungal prophylaxis with regards to the development of these infections. Materials and methods: The retrospective study included 42 patients, of the average age of 35 years, who underwent the allo-SCT program, between 2017 to 2019, and received antifungal prophylaxis at the Clinic for Hematology of the Clinical Center of Serbia (CCS). Based on information obtained from medical histories, databases were formed. Statistical analysis included descriptive statistical methods that were performed in the SPSS program. Results: Nineteen (45.2%) patients presented with the clinical manifestation of oral candidiasis. Invasive pulmonary aspergillosis developed in only 3 (7.1%) patients. There was a statistically significant association between clinically manifest aspergillosis (7.1%) and the presence of antigens (Galactomannan) in these patients (p <0.001). There was also a statistically significant association between clinically manifest aspergillosis and graft weakness: 2 (66.6%) vs. 1 (33.3%), (p = 0.016). Conclusion: The use of adequate antifungal prophylaxis significantly reduces the incidence of IFIs in patients undergoing the allo-SCT program, and this contributes to the reduction of morbidity and mortality.

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