Caspofungin as antifungal prophylaxis in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation: a retrospective analysis.
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Caspofungin as antifungal prophylaxis in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation: a retrospective analysis. / Döring, Michaela; Hartmann, Ulrike; Erbacher, Annika; Lang, Peter; Handgretinger, Rupert; Müller, Ingo.
In: BMC INFECT DIS, Vol. 12, 2012, p. 151.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Caspofungin as antifungal prophylaxis in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation: a retrospective analysis.
AU - Döring, Michaela
AU - Hartmann, Ulrike
AU - Erbacher, Annika
AU - Lang, Peter
AU - Handgretinger, Rupert
AU - Müller, Ingo
PY - 2012
Y1 - 2012
N2 - BACKGROUND: Pediatric patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) often receive intravenous liposomal amphotericin B (L-AmB) as antifungal prophylaxis. There are no guidelines for antifungal prophylaxis in children in this situation. Caspofungin (CAS), a broad-spectrum echinocandin, could be an effective alternative with lower nephrotoxicity than L-AmB.METHODS: We retrospectively analyzed the safety, feasibility, and efficacy of CAS in our center, and compared the results with L-AmB as antifungal monoprophylaxis in pediatric patients undergoing HSCT. 60 pediatric patients received L-AmB (1 or 3 mg/kg bw/day) and another 60 patients received CAS (50 mg/m2/day) as antifungal monoprophylaxis starting on day one after HSCT. The median ages of patients receiving L-AmB and CAS were 7.5 years and 9.5 years, respectively.RESULTS: No proven breakthrough fungal infection occurred in either group during the median treatment period of 23 days in the L-AmB group and 24 days in the CAS group. One patient receiving CAS developed probable invasive aspergillosis. During L-AmB treatment, potassium levels significantly decreased below normal values. Patients treated with L-AmB had more drug-related side effects and an increased need for oral supplementation with potassium, sodium bicarbonate and calcium upon discharge as compared with the CAS group. CAS was well-tolerated and safe in this cohort of immunocompromised pediatric patients, who underwent high-dose chemotherapy and HSCT.CONCLUSION: Prophylactic CAS and L-AmB showed similar efficacy in this biggest cohort of pediatric patients after allogeneic HSCT reported, so far. A prospective randomized trial in children is warranted to allow for standardized guidelines.
AB - BACKGROUND: Pediatric patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) often receive intravenous liposomal amphotericin B (L-AmB) as antifungal prophylaxis. There are no guidelines for antifungal prophylaxis in children in this situation. Caspofungin (CAS), a broad-spectrum echinocandin, could be an effective alternative with lower nephrotoxicity than L-AmB.METHODS: We retrospectively analyzed the safety, feasibility, and efficacy of CAS in our center, and compared the results with L-AmB as antifungal monoprophylaxis in pediatric patients undergoing HSCT. 60 pediatric patients received L-AmB (1 or 3 mg/kg bw/day) and another 60 patients received CAS (50 mg/m2/day) as antifungal monoprophylaxis starting on day one after HSCT. The median ages of patients receiving L-AmB and CAS were 7.5 years and 9.5 years, respectively.RESULTS: No proven breakthrough fungal infection occurred in either group during the median treatment period of 23 days in the L-AmB group and 24 days in the CAS group. One patient receiving CAS developed probable invasive aspergillosis. During L-AmB treatment, potassium levels significantly decreased below normal values. Patients treated with L-AmB had more drug-related side effects and an increased need for oral supplementation with potassium, sodium bicarbonate and calcium upon discharge as compared with the CAS group. CAS was well-tolerated and safe in this cohort of immunocompromised pediatric patients, who underwent high-dose chemotherapy and HSCT.CONCLUSION: Prophylactic CAS and L-AmB showed similar efficacy in this biggest cohort of pediatric patients after allogeneic HSCT reported, so far. A prospective randomized trial in children is warranted to allow for standardized guidelines.
KW - Humans
KW - Male
KW - Female
KW - Adolescent
KW - Child
KW - Child, Preschool
KW - Infant
KW - Retrospective Studies
KW - Immunocompromised Host
KW - Antifungal Agents/administration & dosage/adverse effects
KW - Chemoprevention/adverse effects/methods
KW - Mycoses/prevention & control
KW - Amphotericin B/administration & dosage/adverse effects
KW - Echinocandins/administration & dosage/adverse effects
KW - Hematopoietic Stem Cell Transplantation/adverse effects
KW - Transplantation, Homologous/adverse effects
KW - Humans
KW - Male
KW - Female
KW - Adolescent
KW - Child
KW - Child, Preschool
KW - Infant
KW - Retrospective Studies
KW - Immunocompromised Host
KW - Antifungal Agents/administration & dosage/adverse effects
KW - Chemoprevention/adverse effects/methods
KW - Mycoses/prevention & control
KW - Amphotericin B/administration & dosage/adverse effects
KW - Echinocandins/administration & dosage/adverse effects
KW - Hematopoietic Stem Cell Transplantation/adverse effects
KW - Transplantation, Homologous/adverse effects
U2 - 10.1186/1471-2334-12-151
DO - 10.1186/1471-2334-12-151
M3 - SCORING: Journal article
C2 - 22747637
VL - 12
SP - 151
JO - BMC INFECT DIS
JF - BMC INFECT DIS
SN - 1471-2334
ER -
