Caspofungin as antifungal prophylaxis in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation: a retrospective analysis
<p>Abstract</p> <p>Background</p> <p>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 child...
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BMC
2012-07-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | http://www.biomedcentral.com/1471-2334/12/151 |
| _version_ | 1818542398277419008 |
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| author | Döring Michaela Hartmann Ulrike Erbacher Annika Lang Peter Handgretinger Rupert Müller Ingo |
| author_facet | Döring Michaela Hartmann Ulrike Erbacher Annika Lang Peter Handgretinger Rupert Müller Ingo |
| author_sort | Döring Michaela |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>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/m<sup>2</sup>/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.</p> <p>Results</p> <p>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.</p> <p>Conclusion</p> <p>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.</p> |
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| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-11T22:21:33Z |
| publishDate | 2012-07-01 |
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| series | BMC Infectious Diseases |
| spelling | doaj.art-554f47896968428281fae77e8d0cc17b2022-12-22T00:48:25ZengBMCBMC Infectious Diseases1471-23342012-07-0112115110.1186/1471-2334-12-151Caspofungin as antifungal prophylaxis in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation: a retrospective analysisDöring MichaelaHartmann UlrikeErbacher AnnikaLang PeterHandgretinger RupertMüller Ingo<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>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/m<sup>2</sup>/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.</p> <p>Results</p> <p>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.</p> <p>Conclusion</p> <p>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.</p>http://www.biomedcentral.com/1471-2334/12/151CaspofunginLiposomal amphotericin BAntifungal prophylaxisPediatric patientsAllogeneic stem cell transplantation |
| spellingShingle | Döring Michaela Hartmann Ulrike Erbacher Annika Lang Peter Handgretinger Rupert Müller Ingo Caspofungin as antifungal prophylaxis in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation: a retrospective analysis BMC Infectious Diseases Caspofungin Liposomal amphotericin B Antifungal prophylaxis Pediatric patients Allogeneic stem cell transplantation |
| title | Caspofungin as antifungal prophylaxis in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation: a retrospective analysis |
| title_full | Caspofungin as antifungal prophylaxis in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation: a retrospective analysis |
| title_fullStr | Caspofungin as antifungal prophylaxis in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation: a retrospective analysis |
| title_full_unstemmed | Caspofungin as antifungal prophylaxis in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation: a retrospective analysis |
| title_short | Caspofungin as antifungal prophylaxis in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation: a retrospective analysis |
| title_sort | caspofungin as antifungal prophylaxis in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation a retrospective analysis |
| topic | Caspofungin Liposomal amphotericin B Antifungal prophylaxis Pediatric patients Allogeneic stem cell transplantation |
| url | http://www.biomedcentral.com/1471-2334/12/151 |
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