Secondary Antifungal Prophylaxis in Pediatric Hematopoietic Stem Cell Transplants

Azık, Fatih Mehmet; Tezer, Hasan; Özkaya-Parlakay, Aslınur; Aksu, Tekin; Bayram, Cengiz; Fettah, Ali; Tavil, Betül; Tunç, Bahattin

doi:10.1097/mph.0000000000000175

Cited by 7 publications

(6 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Interestingly, the increased incidence of acute GvHD did not negatively affect the OS, which could be explained by the better treatment options for moderate‐to‐severe GvHD in recent years, as reported by others . Also, prophylaxis using new antifungals in patients with moderate and severe acute GvHD may have improved their survival in the last few years .…”

Section: Discussionsupporting

confidence: 58%

Improved overall survival for pediatric patients undergoing allogeneic hematopoietic stem cell transplantation – A comparison of the last two decades

Svenberg

Remberger

Uzunel

et al. 2016

Pediatric Transplantation

View full text Add to dashboard Cite

Pediatric protocols for allogeneic hematopoietic SCT have been altered during the last two decades. To compare the outcomes in children (<18 yr old), who underwent SCT at our center during 1992-2002 (P1) and 2003-2013 (P2). We retrospectively analyzed 188 patients in P1 and 201 patients in P2. The most significant protocol changes during P2 compared with P1 were a decrease in MAC protocols, particularly those containing TBI, an increase in RIC protocols, and altered GvHD prophylaxis. In addition, P2 had more patients with nonmalignant diagnoses (p = 0.002), more mismatched (MM) donors (p = 0.01), and more umbilical CB grafts (p = 0.03). Mesenchymal or DSCs were used for severe acute GvHD during P2. Three-yr OS in P1 was 58%, and in P2, it was 78% (p < 0.001). Improved OS was seen in both malignant disorders (51% vs. 68%; p = 0.05) and nonmalignant disorders (77% vs. 87%; p = 0.04). Multivariate analysis showed that SCT during P2 was associated with reduced mortality (HR = 0.57; p = 0.005), reduced TRM (HR = 0.57; p = 0.03), unchanged relapse rate, similar rate of GF, less chronic GvHD (HR = 0.49; p = 0.01), and more acute GvHD (HR = 1.77, p = 0.007). During recent years, OS has improved at our center, possibly reflecting the introduction of less toxic conditioning regimens and a number of other methodological developments in SCT.

show abstract

Section: Discussionsupporting

confidence: 58%

Improved overall survival for pediatric patients undergoing allogeneic hematopoietic stem cell transplantation – A comparison of the last two decades

Svenberg

Remberger

Uzunel

et al. 2016

Pediatric Transplantation

View full text Add to dashboard Cite

show abstract

“…Antifungal prophylaxis after treatment of IFD has been used successfully in HSCT to reduce the risk of developing new or recurrent IFD (Cordonnier et al ., ; Maziarz et al ., ). Secondary prophylaxis has been shown to be safe and effective in children and has resulted in greatly decreased fungal‐related mortality (Dvorak et al ., ; Azik et al ., ). The choice of antifungal agent for secondary prophylaxis should be tailored to a patient's underlying disease, prior IFD and clinical status.…”

Section: Prevention Of Invasive Fungal Diseasementioning

confidence: 97%

Fungal infections in children with haematologic malignancies and stem cell transplant recipients

Otto

Green

2020

Br J Haematol

View full text Add to dashboard Cite

Children with haematologic malignancies and haematopoietic stem cell transplant recipients are at high risk for invasive fungal diseases (IFD). There has been an increased number of at-risk children over the past two decades due to improvements in cancer therapies resulting in improved survival of children with high-risk and refractory malignancies. The predominant organisms that cause IFD include Candida spp., Aspergillus spp. and the Mucorales molds. Clinical presentations of IFD vary based on host immune status and the causative organism. Though serum biomarkers such as the galactomannan assay and beta-D-glucan assay have been validated in adults, there are limited data regarding their diagnostic value in children. Thus, the gold standard for IFD diagnosis remains tissue biopsy with histopathological and microbiological evaluation. Treatment of IFD is multimodal and involves antifungal drugs, correction of immune dysfunction and surgical resection when feasible. Paediatric practice regarding IFD is largely extrapolated from data generated in adult patients; in this review, we evaluate both primary paediatric studies and guidelines intended for adult patients that are applied to paediatric patients. There remain significant knowledge gaps with respect to the prevention, diagnosis and treatment of IFD in immunocompromised children, and further research is needed to help guide management decisions.

show abstract

“…Seven reports examined patients receiving L-AMB daily, [15][16][17][19][20][21][22] while two studies had patients receiving L-AMB weekly, 14,18 and one study involved L-AMB administered three times a week. 12…”

Section: Dosingmentioning

confidence: 99%

“…Nephrotoxicity was observed in five studies, 12,14,16,20,21 with a pooled estimate of 36% (95% CI: 0.03-0.77) (Figure 8). Hypokalemia was noted in three studies, 14,16,18 with a pooled estimate of 12% (95% CI: 0.00-0.42) (Figure 9). Treatment discontinuation due to adverse effects occurred in six studies, with a pooled estimate of 15% (95% CI: 0.01-0.39) (Figure 10).…”

Section: Safety Outcomesmentioning

confidence: 99%

Liposomal amphotericin for secondary prophylaxis: A systematic review and meta-analysis

Javandoust Gharehbagh,

Roshanzamiri,

Farjami

et al. 2024

J Oncol Pharm Pract

View full text Add to dashboard Cite

Introduction This systematic review and meta-analysis aimed to determine the safety of liposomal amphotericin B (L-AMB) compared to other antifungal agents for secondary prophylaxis. Method We conducted a comprehensive search across international databases and reference lists of articles to compile all relevant published evidence evaluating the efficacy and safety of L-AMB versus other antifungals (NLAMB) for secondary prophylaxis against invasive fungal infections. Pooled estimates were calculated after data transformation to evaluate mortality, breakthrough infections, and the frequency of adverse effects, including hypokalemia and nephrotoxicity. Comparisons of breakthrough fungal infection and mortality between the L-AMB and NLAMB groups were performed. Result We identified 10 studies. The cumulative frequency of patients using L-AMB was 148, compared to 341 patients in the NLAMB group. The mortality rates in the L-AMB and NLAMB groups were 10% and 0%, respectively. However, based on the odds ratio, the mortality in the L-AMB group was lower than that in the NLAMB group. No significant difference was observed in breakthrough invasive fungal infections between the L-AMB and NLAMB groups. The frequencies of nephropathy and hypokalemia in the L-AMB group were 36% and 18%, respectively. Conclusion Our findings indicate a lower incidence of mortality in the L-AMB group compared to the NLAMB group. No statistically significant difference was observed in the incidence of breakthrough infection between the two groups. L-AMB administration is associated with nephropathy and hypokalemia. However, the refusal to continue treatment due to adverse effects is not significantly high.

show abstract

Secondary Antifungal Prophylaxis in Pediatric Hematopoietic Stem Cell Transplants

Cited by 7 publications

References 30 publications

Improved overall survival for pediatric patients undergoing allogeneic hematopoietic stem cell transplantation – A comparison of the last two decades

Improved overall survival for pediatric patients undergoing allogeneic hematopoietic stem cell transplantation – A comparison of the last two decades

Fungal infections in children with haematologic malignancies and stem cell transplant recipients

Liposomal amphotericin for secondary prophylaxis: A systematic review and meta-analysis

Contact Info

Product

Resources

About