Blood Res.  2022 Mar;57(1):34-40. 10.5045/br.2021.2021127.

Prophylaxis for invasive fungal infection in pediatric patients with allogeneic hematopoietic stem cell transplantation

• Perez P
• Patiño J
• Franco AA
• Rosso F
• Beltran E
• Manzi E
• Castro A
• Estacio M
• Valencia DM

• KMID: 2527495
• DOI: http://doi.org/10.5045/br.2021.2021127

Abstract

Background
Antifungal prophylaxis is recommended for hematopoietic stem cell transplantation (HSCT) to decrease the incidence of invasive fungal infections (IFI). This study aimed to compare the two groups of antifungal prophylaxis in pediatric patients undergoing allogeneic HSCT.
Methods
This observational, analytic, retrospective cohort study compared the incidence of IFI with antifungal prophylaxis with voriconazole vs. other antifungals in the first 100 days after allogeneic HSCT in patients aged ＜18 years between 2012 and 2018. The statistical analysis included univariate and multivariate analyses and determination of the cumulative incidence of invasive fungal infection by the Kaplan‒Meier method using STATA 14 statistical software.
Results
A total of 139 allogeneic HSCT were performed. The principal diagnosis was acute leukemia (63%). The 75% had haploidentical donors, and 50% used an antifungal in the month before transplantation. Voriconazole (69%) was the most frequently administered antifungal prophylaxis. The cumulative incidence of IFI was 5% (7 cases). Of the patients with IFIs, four began prophylaxis with voriconazole, one with caspofungin, and one with fluconazole. Additionally, six were possible cases, one was proven (Candida parapsilosis), and 1/7 died.
Conclusion
There were no differences in the incidence of IFI between patients who received prophylaxis with voriconazole and other antifungal agents.

Keyword

Invasive fungal infections; Antifungal agents; Pediatrics; Hematopoietic stem cell transplantation; Mortality

Figure

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  Fig. 1 100-days overall survival was 81% (A), the 100-day cumulative incidence of invasive fungal infection was 5.3% (B), and incidence of invasive fungal infection according to prophylaxis with voriconazole (4.4%) or another (7.4%) antifungal (C) at 100 days post-allogeneic hematopoietic stem cell trans-plantation.

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