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.
Keywords: Pediatric; Leukemia; Invasive fungal infection;
Combined antifungal therapy