Clinical Experience of Antifungal Combination Therapy for Invasive
Fungal Infections in Pediatric Hematological Malignancy Patients
Abstract
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.