Voriconazole Antifungal Prophylaxis in Children With Malignancies: A Nationwide Study. Issue 1 (January 2018)

• Record Type: Journal Article
• Authors: Pana, Zoi Dorothea; Kourti, Maria; Vikelouda, Katerina; Vlahou, Antonia; Katzilakis, Nikolaos; Papageorgiou, Maria; Doganis, Dimitrios; Petrikkos, Loizos; Paisiou, Anna; Koliouskas, Dimitrios; Kattamis, Antonios; Stiakaki, Eftichia; Chatzistilianou, Maria; Vasilatou-Kosmidis, Helen; Polychronopoulou, Sophia; Grafakos, Stelios; Roilides, Emmanuel
• Is Part Of: Journal of pediatric hematology/oncology. Volume 40:Issue 1(2018)
• Publication Date: 2018-01
• Subjects: voriconazole -- antifungal prophylaxis -- leukemia -- safety -- efficacy -- adverse events; Pediatric hematology -- Periodicals; Tumors in children -- Periodicals; 618.9215
• DOI: 10.1097/MPH.0000000000000926
• Languages: English
• ISSNs: 1077-4114

Abstract

Abstract : Background: Antifungal prophylaxis (AFP) is recommended in at-risk hematology-oncology patients. We evaluated the safety of AFP with voriconazole (VRC) in pediatric hematology/oncology patients. Materials and Methods: A retrospective study of VRC AFP in children with malignancies hospitalized in all 7 Greek pediatric hematology/oncology centers during 2008 to 2012 was conducted. Patients' demographics, outcome, and adverse event (AE) data were recorded. Results: Four hundred twenty-nine VRC AFP courses in 249 patients (median age 6 y, 55% boys) were studied. The most common underlying diseases were acute lymphoblastic leukemia (51%), non Hodgkin lymphoma (8.6%), and acute myeloid leukemia (7.7%). The median number of VRC courses per patient was 1.7, whereas the median VRC dose was 7 mg/kg (range, 5 to 7 mg/kg) every 12 hours. During the last 2 weeks before AFP, 51% of the patients had received corticosteroids, 43% suffered from severe neutropenia, and 17.3% from mucositis. The median duration of VRC AFP was 17 days (range, 1 to 31 d). A single breakthrough fungemia due to Candida glabrata was recorded. Only 1 patient died due to the underlying disease. The most common AEs reported in 70/429 (16.3%) courses with ≥1 AE were elevated liver enzymes (50%), hypokalemia (24.3%), and ophthalmological disorders (14.3%). The median time of AE onset was 5 days (range, 1 to 21 d). Among 70 AEs reported, 38.5%, 48.4%, and 12.8% were of grade I, II, and III, respectively. Conclusions: VRC prophylaxis in pediatric hematology/oncology patients appears to be well tolerated.