Contributions
Abstract: EP355
Type: E-Poster Presentation
Session title: Acute lymphoblastic leukemia - Clinical
Background
Despite improvements in diagnosis and management, invasive fungal infections (IFIs) remain a major cause of morbidity and mortality in children receiving chemotherapy. Therefore, primary antifungal prophylaxis (PAP) has been recommended for patients treated in centers with a high incidence of IFI.
Aims
The aims of this study were to determine the effects of PAP on incidence, morbidity and mortality in children with acute lymphoblastic leukemia (ALL) and to compare those results with the historical study.
Methods
Children with ALL who were diagnosed before 31th January 2013, did not receive any primary antifungal prophylaxis (NoP Group), the patients who were diagnosed ALL between 1st February 2013 and 31st Jan 2020 received voriconazole (VCZ) as PAP(AFP Group).
PAP was started following the first occurrence of neutropenia after the diagnosis of ALL. VCZ was given 2x 9 mg/kg/ day per orally. If the patients had febrile neutropenia VCZ was switched to intravenous route. Because of the interaction of the drugs, during induction and reinduction phases of chemotherapy protocol patients did not receive VCZ on the days when they were given vincristine (7th, 15th, 22nd and 29th days of induction and reinduction phases). Additionally, patients who were stratified in the high risk group didn’t receive VCZ during HR Blocks for the same reason. They were given liposomal amphotericin B at the dose of 3 mg/ kg/ day during HR block therapies.
The medical records of the children with ALL who were diagnosed after February 2013, were retrospectively reviewed. The chart review of the patients who underwent PAP and developed a proven or probable IFI according to EORTC (as in historical study) was completed.
Results
During the study period 166 children were diagnosed ALL and received PAP together with chemotherapy. Twenty-three patients (13.9%) with a mean age of 98.6 months (6.8- 206.0) were determined and male to female ratio was 9/14. The proven and probable IFI incidence was (13.9%) which was less than previous study (24%). Seventeen (73.9%) of 23 episodes were defined as proven IFI and 6 (26.1%) episodes were defined as probable IFI. The proven IFI incidence was similar to previous study (10.2% vs. 14.6%). However, there was a decline in probable IFI incidence (3.6% vs.10.4%). The majority of proven IFIs were candidemia (15/17;88.2%), one episode was caused by Rhizopus spp. (1/17;5.8%) as previous report and one episode was caused by Fusarium spp. (1/17;5.8%). Seventeen patients (73.9%) were neutropenic (<500/mm3) at the time of IFI diagnosis. None of the children developed major adverse events due to voriconazole that could lead discontinuation of voriconazole. Attributable mortality and crude mortality was 4.3%.
Conclusion
Primary prophylaxis has been recommended for centers with a high incidence of IFI. This study showed dramatically decline in probable IFI episodes those were commonly caused by a mold. In our study, the majority of proven IFI episode were due to Candida spp. one of the proven IFI episode was casued by Rhizopus and the other one was caused by Fusarium spp. Breakthrough Mucor infections under voriconazole prophylaxis had been well described. However, there was no increase in the incidence of Mucorales spp. caused infections. In conclusion, voriconazole was well tolerated and had effects on the incidence of mold infections. However, significant effect was not observed in the incidence of yeast infections.
Keyword(s): Leukemia, Voriconazole
Abstract: EP355
Type: E-Poster Presentation
Session title: Acute lymphoblastic leukemia - Clinical
Background
Despite improvements in diagnosis and management, invasive fungal infections (IFIs) remain a major cause of morbidity and mortality in children receiving chemotherapy. Therefore, primary antifungal prophylaxis (PAP) has been recommended for patients treated in centers with a high incidence of IFI.
Aims
The aims of this study were to determine the effects of PAP on incidence, morbidity and mortality in children with acute lymphoblastic leukemia (ALL) and to compare those results with the historical study.
Methods
Children with ALL who were diagnosed before 31th January 2013, did not receive any primary antifungal prophylaxis (NoP Group), the patients who were diagnosed ALL between 1st February 2013 and 31st Jan 2020 received voriconazole (VCZ) as PAP(AFP Group).
PAP was started following the first occurrence of neutropenia after the diagnosis of ALL. VCZ was given 2x 9 mg/kg/ day per orally. If the patients had febrile neutropenia VCZ was switched to intravenous route. Because of the interaction of the drugs, during induction and reinduction phases of chemotherapy protocol patients did not receive VCZ on the days when they were given vincristine (7th, 15th, 22nd and 29th days of induction and reinduction phases). Additionally, patients who were stratified in the high risk group didn’t receive VCZ during HR Blocks for the same reason. They were given liposomal amphotericin B at the dose of 3 mg/ kg/ day during HR block therapies.
The medical records of the children with ALL who were diagnosed after February 2013, were retrospectively reviewed. The chart review of the patients who underwent PAP and developed a proven or probable IFI according to EORTC (as in historical study) was completed.
Results
During the study period 166 children were diagnosed ALL and received PAP together with chemotherapy. Twenty-three patients (13.9%) with a mean age of 98.6 months (6.8- 206.0) were determined and male to female ratio was 9/14. The proven and probable IFI incidence was (13.9%) which was less than previous study (24%). Seventeen (73.9%) of 23 episodes were defined as proven IFI and 6 (26.1%) episodes were defined as probable IFI. The proven IFI incidence was similar to previous study (10.2% vs. 14.6%). However, there was a decline in probable IFI incidence (3.6% vs.10.4%). The majority of proven IFIs were candidemia (15/17;88.2%), one episode was caused by Rhizopus spp. (1/17;5.8%) as previous report and one episode was caused by Fusarium spp. (1/17;5.8%). Seventeen patients (73.9%) were neutropenic (<500/mm3) at the time of IFI diagnosis. None of the children developed major adverse events due to voriconazole that could lead discontinuation of voriconazole. Attributable mortality and crude mortality was 4.3%.
Conclusion
Primary prophylaxis has been recommended for centers with a high incidence of IFI. This study showed dramatically decline in probable IFI episodes those were commonly caused by a mold. In our study, the majority of proven IFI episode were due to Candida spp. one of the proven IFI episode was casued by Rhizopus and the other one was caused by Fusarium spp. Breakthrough Mucor infections under voriconazole prophylaxis had been well described. However, there was no increase in the incidence of Mucorales spp. caused infections. In conclusion, voriconazole was well tolerated and had effects on the incidence of mold infections. However, significant effect was not observed in the incidence of yeast infections.
Keyword(s): Leukemia, Voriconazole