Antifungal Combination Therapy in Children with Cancer—A 4-Year Analysis of Real-Life Data of Two Major Pediatric Cancer Centers

Clinical data on antifungal combination therapy are limited, in particular in the pediatric setting. We analyzed real-life data collected in two major pediatric cancer centers over a period of 4 years. Patients were identified in an observational study on children with acute leukemia and lymphoma or...

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Bibliographic Details
Published in:Journal of fungi (Basel) 2021-07, Vol.7 (8), p.604
Main Authors: Schöning, Stefan, Bochennek, Konrad, Gordon, Kathrin, Groll, Andreas H., Lehrnbecher, Thomas
Format: Article
Language:English
Subjects:
antifungal combination therapy
Cancer
Cancer therapies
Caspofungin
Chemotherapy
Children
Creatinine
Disease prevention
hematopoietic cell transplantation
Immunocompromised hosts
Infections
invasive fungal disease
Invasiveness
Laboratories
Leukemia
Lymphoma
Mortality
Neutropenia
Patients
Pediatrics
Prophylaxis
Sepsis
Skin diseases
Skin lesions
Transplantation
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Summary:Clinical data on antifungal combination therapy are limited, in particular in the pediatric setting. We analyzed real-life data collected in two major pediatric cancer centers over a period of 4 years. Patients were identified in an observational study on children with acute leukemia and lymphoma or undergoing hematopoietic cell transplantation. Out of 438 patients, 19 patients received 21 episodes of antifungal combination therapy. Therapy was mostly started for sepsis (n = 5) or clinical deterioration with pulmonary infiltrates (n = 10), and less often for periorbital swelling with suspected mold infection (n = 2), clinical deterioration and new skin lesions, secondary antifungal prophylaxis, a persistently elevated galactomannan index, or as pre-emptive treatment (n = 1 each). Diagnostics revealed proven, probable, and possible invasive fungal disease in two, seven and four episodes, respectively. Most regimens included caspofungin (n = 19), and treatment was initiated as first line therapy in 10 episodes. The median duration was 13 days (4–46 days). Nine of the 13 patients with proven, probable, or possible invasive fungal disease survived, which was comparable to patients receiving antifungal monotherapy. Our analysis demonstrates that combination therapy has mainly been prescribed in selected immunocompromised patients with clinical deterioration due to suspected invasive fungal disease or those with sepsis, and is well tolerated. Future studies need to better characterize clinical settings in which patients may benefit from antifungal combination therapy.
ISSN:2309-608X
2309-608X
DOI:10.3390/jof7080604