Prophylaxis for invasive fungal infection in pediatric patients with allogeneic hematopoietic stem cell transplantation

Abstract

Background: Antifungal prophylaxis is recommended for hematopoietic stem cell transplantation (HSCT) to decrease the incidence of invasive fungal infections (IFI). This study aimed to compare the two groups of antifungal prophylaxis in pediatric patients undergoing allogeneic HSCT.Methods: This observational, analytic, retrospective cohort study compared the incidence of IFI with antifungal prophylaxis with voriconazole vs. other antifungals in the first 100 days after allogeneic HSCT in patients aged <18 years between 2012 and 2018. The statistical analysis included univariate and multivariate analyses and determination of the cumulative incidence of invasive fungal infection by the Kaplan-Meier method using STATA 14 statistical software.Results: A total of 139 allogeneic HSCT were performed. The principal diagnosis was acute leukemia (63%). The 75% had haploidentical donors, and 50% used an antifungal in the month before transplantation. Voriconazole (69%) was the most frequently administered antifungal prophylaxis. The cumulative incidence of IFI was 5% (7 cases). Of the patients with IFIs, four began prophylaxis with voriconazole, one with caspofungin, and one with fluconazole. Additionally, six were possible cases, one was proven (Candida parapsilosis), and 1/7 died. Conclusion:There were no differences in the incidence of IFI between patients who received prophylaxis with voriconazole and other antifungal agents.

Antifungal stewardship: the Latin American experience

“…The published data of 251 children with autologous or allogeneic HPCT in Argentina 46 describe that until 2006 they used fluconazole and then switched to voriconazole as IFI prophylaxis. During an experience at a children’s hospital, which included the management of 139 HSCT recipients in Colombia, 47 reported that the results with the use of voriconazole prophylaxis, the frequency of IFI was 4.4 vs. 7.4% with use of other prophylactic antifungals, with no statistically significant difference (Table 3 ).…”

“…During an experience at a children's hospital, which included the management of 139 HSCT recipients in Colombia, 47 reported that the results with the use of voriconazole prophylaxis, the frequency of IFI was 4.4 vs. 7.4% with use of other prophylactic antifungals, with no statistically significant difference (Table 3). The clinical guidelines for the management of NF published in the region in 2005 recommend the use of empirical antifungal therapy to the extent that NF patients persist febrile on the 7th day despite appropriate antibacterial therapy.…”

Successful Treatment of Rare Pulmonary Coprinopsis cinerea Infection in a 17-Year-Old Female After Hematopoietic Stem Cell Transplantation: A Case Report

“… 1 Administration of high-dose chemotherapy, immunosuppressive agents, steroids, and broad-spectrum antibiotics increases the incidence of IFIs in HSCT recipients and patients with hematological disorders. 2 , 3 In addition, IFIs often exhibit rapid disease progression and a slow response to treatment, leading to limitations in diagnosing them and treatment delays. 3 …”

“…1 Administration of high-dose chemotherapy, immunosuppressive agents, steroids, and broad-spectrum antibiotics increases the incidence of IFIs in HSCT recipients and patients with hematological disorders. 2,3 In addition, IFIs often exhibit rapid disease progression and a slow response to treatment, leading to limitations in diagnosing them and treatment delays. 3 Although antifungal prophylaxis is recommended in most cases of HSCT, the risk of developing an IFI remains high, particularly in patients with co-existing with other complications, such as prolonged neutropenia, severe viral and bacterial infections, and graft-versus-host diseases (GVHDs).…”

“…3 Although antifungal prophylaxis is recommended in most cases of HSCT, the risk of developing an IFI remains high, particularly in patients with co-existing with other complications, such as prolonged neutropenia, severe viral and bacterial infections, and graft-versus-host diseases (GVHDs). 1,2 In addition, IFIs on antifungal prophylaxis in HSCT patients often have an insidious onset, which may increase the risk of misdiagnosis and delay treatment.…”