Antifungal Combination Therapy in Children with Cancer—A 4-Year Analysis of Real-Life Data of Two Major Pediatric Cancer Centers
Abstract
:1. Introduction
2. Patients and Methods
3. Results
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Patient # | Age (y)/Sex | Underlying Malignancy | Therapy | Neutrophil Count Prior to Combination Therapy (mm3) |
---|---|---|---|---|
1 | 12/boy | ALL | HCT | 0 |
2 | 4/boy | Immunodeficiency | HCT | 500 |
3 | 11/boy | Rhabdomyosarcoma | HCT | 130 |
4 | 17/girl | ALL | Chemotherapy | 70 |
5 | 6/boy | AML | Chemotherapy and HCT | 110 |
6 | 14/boy | AML | HCT | 20 |
7 | 17/boy | ALL | HCT | 100 |
8 | 14/girl | DBA | HCT | 200 |
9 | 9/boy | ALL | HCT/HCT | 3100 |
10 | 8/boy | Fanconi anemia | HCT | 2340 |
11 | 5/boy | ALL | Chemotherapy | 20 |
12 | 9/girl | AML | HCT | 20 |
13 | 1/boy | AML | Chemotherapy | 10 |
14 | 0.4/girl | Immunodeficiency | HCT | 110 |
15 | 14/boy | MDS | HCT | 1260 |
16 | 15/boy | Aplastic anemia | HCT | 18,000 |
17 | 17/boy | ALL | Chemotherapy | 50 |
18 | 13/boy | Aplastic anemia | HCT | 0 |
19 | 5/girl | ALL | HCT | 2110 |
Antifungal Treatment Prior to Combination Therapy (Days) | Indication for Combination Therapy | IFD (Fungal Pathogen) | Combination Therapy | Antifungal Treatment after Combination Therapy (Days) | Outcome | ||
---|---|---|---|---|---|---|---|
Patient # | Agents | Duration (Days) | |||||
1 | None | sepsis | no | caspo + LAMB | 14 | monotherapy caspo (5) | alive |
2 | monotherapy LAMB (44), vori (81) | clinical deterioration, pulmonary infiltrates | proven invasive aspergillosis | vori + LAMB | 10 | none | death (invasive aspergillosis) |
3 | monotherapy mica (14), LAMB (14) | clinical deterioration, pulmonary infiltrates | proven (C.krusei) | caspo + vori | 14 | monotherapy caspo (15) | death (multifactorial) |
4 | None | periorbital swelling | no | caspo + LAMB | 4 | none | alive |
5 | monotherapy mica (22) | clinical deterioration, pulmonary infiltrates | probable invasive aspergillosis | caspo + mica | 12 | monotherapy vori (84) | alive |
caspo + vori | 21 | ||||||
5 (second episode) | monotherapy LAMB (4) | clinical deterioration, pulmonary infiltrates | probable invasive aspergillosis | caspo + LAMB | 30 | monotherapy mica (28) | alive |
6 | monotherapy caspo (2) | sepsis | no | caspo + LAMB | 6 | monotherapy caspo (4) | alive |
7 | monotherapy LAMB (14) | sepsis | no | caspo + LAMB | 4 | none | alive |
8 | monotherapy mica (31) | persistent positive galactomannan index | possible (aspergilosis) | caspo + vori | 26 | monotherapy vori (176) | alive |
mica + vori | 11 | ||||||
caspo + vori | 18 | ||||||
9 | None | secondary prophylaxis | probable invasive aspergillosis | caspo + LAMB | 19 | monotherapy vori (60) | alive |
9 (second episode) | None | clinical deterioration/progress pulmonary infiltrates | probable invasive aspergillosis | casp + LAMB | 16 | death (multifactorial) | |
10 | monotherapy vori (38) | periorbital swelling | no | caspo + posa | 7 | monotherapy posa (42) | alive |
11 | None | sepsis, skin infiltrates | no | LAMB + posa | 17 | monotherapy vori (19) | alive |
12 | None | clinical deterioration, pulmonary infiltrates | possible (mold) | caspo + LAMB | 10 | monotherapy LAMB (48) | alive |
13 | None | pre-emptive therapy, febrile neutropenia | possible (aspergillosis) | vori + LAMB | 46 | monotherapy LAMB (52) | alive |
14 | None | sepsis | no | caspo + LAMB | 13 | monotherapy caspo (30) | death (unrelated to infection) |
15 | monotherapy mica (15) | clinical deterioration, pulmonary infiltrates | possible (mold) | caspo + vori | 10 | none | alive |
16 | monotherapy LAMB (12) | sepsis | no | caspo + LAMB | 4 | monotherapy caspo (33) | alive |
17 | None | clinical deterioration, infiltrates lung and cns | probable invasive aspergillosis | vori + LAMB | 9 | monotherapy vori (11) | alive |
18 | None | clinical deterioration, pulmonary infiltrates | probable invasive aspergillosis | caspo + LAMB | 6 | monotherapy posa (144) | alive |
vori + LAMB | 5 | ||||||
19 | monotherapy LAMB (4) | clinical deterioration, pulmonary infiltrates | probable invasive aspergillosis | caspo + vori + LAMB + posa | 24 | none | death (multifactorial) |
Antifungal Monotherapy | Antifungal Combination Therapy | ||
---|---|---|---|
Proven/probable IFD | 12 | 9 | |
Chemotherapy | |||
alive | 5 | 2 | |
dead | 1 | 0 | |
HCT | |||
alive | 3 | 3 | |
dead | 3 | 4 | |
Possible IFD | 21 | 4 | |
Chemotherapy | |||
alive | 12 | 1 | |
dead | 1 | 0 | |
HCT | |||
alive | 6 | 3 | |
dead | 2 | 0 | |
No IFD | 132 | 8 | |
Chemotherapy | |||
alive | 38 | 0 | |
dead | 2 | 1 | |
HCT | |||
alive | 81 | 7 | |
dead | 11 | 0 |
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Schöning, S.; Bochennek, K.; Gordon, K.; Groll, A.H.; Lehrnbecher, T. Antifungal Combination Therapy in Children with Cancer—A 4-Year Analysis of Real-Life Data of Two Major Pediatric Cancer Centers. J. Fungi 2021, 7, 604. https://doi.org/10.3390/jof7080604
Schöning S, Bochennek K, Gordon K, Groll AH, Lehrnbecher T. Antifungal Combination Therapy in Children with Cancer—A 4-Year Analysis of Real-Life Data of Two Major Pediatric Cancer Centers. Journal of Fungi. 2021; 7(8):604. https://doi.org/10.3390/jof7080604
Chicago/Turabian StyleSchöning, Stefan, Konrad Bochennek, Kathrin Gordon, Andreas H. Groll, and Thomas Lehrnbecher. 2021. "Antifungal Combination Therapy in Children with Cancer—A 4-Year Analysis of Real-Life Data of Two Major Pediatric Cancer Centers" Journal of Fungi 7, no. 8: 604. https://doi.org/10.3390/jof7080604
APA StyleSchöning, S., Bochennek, K., Gordon, K., Groll, A. H., & Lehrnbecher, T. (2021). Antifungal Combination Therapy in Children with Cancer—A 4-Year Analysis of Real-Life Data of Two Major Pediatric Cancer Centers. Journal of Fungi, 7(8), 604. https://doi.org/10.3390/jof7080604