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Clinical Experience of Antifungal Combination Therapy for Invasive Fungal Infections in Pediatric Hematological Malignancy Patients
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  • Saliha Kanık Yüksek,
  • Aslınur Özkaya Parlakay,
  • Belgin Gülhan,
  • Neşe Yaralı,
  • Namık Yaşar Özbek,
  • Hasan Tezer
Saliha Kanık Yüksek
Ankara City Hospital
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Aslınur Özkaya Parlakay
Ankara City Hospital
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Belgin Gülhan
Ankara City Hospital
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Neşe Yaralı
Ankara City Hospital
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Namık Yaşar Özbek
Ankara City Hospital
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Hasan Tezer
Gazi University Faculty of Medicine
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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.

Peer review status:IN REVISION

16 Dec 2020Submitted to International Journal of Clinical Practice
18 Dec 2020Submission Checks Completed
18 Dec 2020Assigned to Editor
17 Jan 2021Review(s) Completed, Editorial Evaluation Pending
19 Jan 20211st Revision Received
20 Jan 2021Assigned to Editor
20 Jan 2021Submission Checks Completed
20 Jan 2021Reviewer(s) Assigned
26 Apr 2021Review(s) Completed, Editorial Evaluation Pending
30 Apr 20212nd Revision Received
04 May 2021Submission Checks Completed
04 May 2021Assigned to Editor
04 May 2021Review(s) Completed, Editorial Evaluation Pending
11 May 2021Editorial Decision: Revise Minor