Antifungal Prophylaxis in Children Receiving Antineoplastic Chemotherapy

Comment on: Invasive fungal infections in children with acute lymphoblastic leukemia

“…1,4 Posaconazole has been demonstrated effective for this indication in adults and even if not still registered in children, there is availability of pediatric dosages according to age and weight, but the risk of severe interactions with vinca alkaloids, which are a cornerstone of pediatric ALL therapy, contraindicates its use. 5 Voriconazole (intravenous or oral) or, probably better, liposomal amphotericin B, which does not present significant risks of interactions, administered two times-a-week intravenously can represent acceptable alternatives in this setting. 4…”

“…International guidelines recommend administration of systemic, mold active antifungal prophylaxis when the incidence of IFD is >10%, and therefore, according to the results of the Australian study and the present data, mold active antifungal prophylaxis could be administered to children with primary nonrelapsing/resistant HR ALL since the beginning of chemotherapy . Posaconazole has been demonstrated effective for this indication in adults and even if not still registered in children, there is availability of pediatric dosages according to age and weight, but the risk of severe interactions with vinca alkaloids, which are a cornerstone of pediatric ALL therapy, contraindicates its use . Voriconazole (intravenous or oral) or, probably better, liposomal amphotericin B, which does not present significant risks of interactions, administered two times‐a‐week intravenously can represent acceptable alternatives in this setting …”

Antifungal Therapy in Pediatric Acute Lymphoblastic Leukemia: A Single-center Experience

“…In the past years, primary antifungal prophylaxis was not routinely recommended for ALL patients. As a result of recent studies, HRG ALL patients and relapsed/refractory ALL patients have been included in the HR group for fungal infection 7,19–21. Primary antifungal prophylaxis is now recommended for these patients.…”

Alternate‐day dosing of posaconazole tablets in children leads to efficient plasma levels

“…4 A possible trick to get around this problem could be to alternate on a daily base the number of tablets in patients needing "fractioned" doses. 5 We tested this hypothesis in an 11-year-old boy weighing 38 kg, with extended chronic graft versus host disease, involving both skin and lungs, developed after allogeneic HSCT for acute lymphoblastic leukemia, and further complicated by an IFD. 1 After obtaining informed consent from parents, the patient received prophylaxis with posaconazole tablets 200 mg and 300 mg 12 hours apart the 1st day, and then, the recommended maintenance dosage of 250 mg/daily 3 was approximated alternating the tablets number: 2 tablets (200 mg) 1 day and 3 tablets (300 mg) the following one.…”