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Voriconazole prophylaxis appeared to improve survival in pediatric AML
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Voriconazole prophylaxis was associated with improved survival in pediatric patients with acute myeloid leukemia, but data indicated that secondary factors could be involved.
“Invasive mould infections are a significant cause of morbidity and mortality in the pediatric cancer population, particularly in patients undergoing aggressive myeloablative chemotherapy and hematopoietic stem cell transplantation,” Gabriela M. Maron, MD, and colleagues from St. Jude Children’s Research Hospital wrote. “Due to the intense immunosuppressive effect of their chemotherapy regimens, children with AML are at high risk for invasive mould infections, particularly Aspergillus spp. infection.”
To assess the use of voriconazole as a prophylactic agent in the pediatric population, Maron and colleagues compared the etiology, predisposing factors and outcomes of invasive mould infections in patients treated for AML (n=222) before and after implementation of voriconazole prophylaxis in a pediatric cancer center.
Researchers found no difference in the number of invasive mould infections between treatment groups, yet observed a difference in isolated organisms, shifting from aspergillosis to phaeohyphomycosis after the implementation of voriconazole prophylaxis.
Maron and colleagues observed that survival at 90 days was improved in patients receiving voriconazole prophylaxis (P=.05); however, they did not identify a significant increase in the incidence of zygomycosis linked to routine use of voriconazole prophylaxis.
“Patients with infections diagnosed following implementation of voriconazole prophylaxis had more favorable outcomes than both those of the comparison group and that reported in the adult literature,” Maron and colleagues wrote. “These favorable outcomes are associated with shorter duration of preceding neutropenia and with receipt of posaconazole as treatment for breakthrough mould infections, which were predominantly phaeohyphomycoses.”
Disclosure: The researchers reported no relevant financial disclosures.
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