Prophylactic use of liposomal amphotericin B in children and adolescents undergoing allogeneic hematopoietic cell transplantation: A 10-years single center experience
Background: Azoles are recommended as antifungal prophylaxis in decreasing the incidence of invasive fungal disease (IFD) in high-risk patients in pediatric oncology, including patients receiving allogeneic hematopoietic cell transplantation (HCT). However, azole related toxicity, pharmacological in...
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Elsevier
2024-12-01
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| Series: | EJC Paediatric Oncology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772610X24000345 |
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| author | Laura G.Y. Rotte Coco C.H. de Koning Yvette G.T. Loeffen Marc B. Bierings Jaap Jan Boelens Caroline A. Lindemans Tom F.W. Wolfs |
| author_facet | Laura G.Y. Rotte Coco C.H. de Koning Yvette G.T. Loeffen Marc B. Bierings Jaap Jan Boelens Caroline A. Lindemans Tom F.W. Wolfs |
| author_sort | Laura G.Y. Rotte |
| collection | DOAJ |
| description | Background: Azoles are recommended as antifungal prophylaxis in decreasing the incidence of invasive fungal disease (IFD) in high-risk patients in pediatric oncology, including patients receiving allogeneic hematopoietic cell transplantation (HCT). However, azole related toxicity, pharmacological interactions with immunosuppressive medication and conditioning regimen and growing incidence of azole resistance makes this antifungal agent not ideal in the transplant setting. This study reports on the contemporary incidence and outcome of IFD after allogeneic HCT in children with prophylactic liposomal amphotericin B (L-AMB). Methods: This single-center retrospective study included all patients transplanted between 2012 and 2022. Primary endpoint was the incidence of IFD until hospital discharge post-transplant. Secondary aims were the incidence of IFD and survival 180 days after allogeneic HCT, the evaluation of toxicity of L-AMB and further risk factors for development of IFD during antifungal prophylaxis. Descriptive statistics were performed. Results: 161 pediatric patients received L-AMB. Incidence of breakthrough IFD post-transplant was 7.5 % (12/161). The 12 cases comprised of three invasive yeast infections (1.9 %), three probable (1.9 %) and six possible (3.7 %) mold infections. Adverse events were in 22.4 % of the patients, most of them mild and reversible. Discontinuation of L-AMB occurred in 2.5 % (4/161) of the patients due to severe hypersensitivity reactions. Conclusions: The risk of breakthrough IFD in pediatric patients undergoing allogeneic HCT under L-AMB prophylaxis is comparable with the reported risk under first line recommendation drugs for antifungal prophylaxis. If no hypersensitivity reaction occurs, L-AMB is tolerated with manageable side effects. This antifungal agent should therefore be considered as an alternative option to azoles in pediatric allogeneic HCT recipients. |
| format | Article |
| id | doaj-art-bed1aed6344440ef8b57bca2205ba559 |
| institution | DOAJ |
| issn | 2772-610X |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EJC Paediatric Oncology |
| spelling | doaj-art-bed1aed6344440ef8b57bca2205ba5592025-08-20T02:50:16ZengElsevierEJC Paediatric Oncology2772-610X2024-12-01410017510.1016/j.ejcped.2024.100175Prophylactic use of liposomal amphotericin B in children and adolescents undergoing allogeneic hematopoietic cell transplantation: A 10-years single center experienceLaura G.Y. Rotte0Coco C.H. de Koning1Yvette G.T. Loeffen2Marc B. Bierings3Jaap Jan Boelens4Caroline A. Lindemans5Tom F.W. Wolfs6Hematopoietic Stem Cell Transplantation, Princess Maxima Center for Pediatric Oncology, Utrecht, the NetherlandsHematopoietic Stem Cell Transplantation, Princess Maxima Center for Pediatric Oncology, Utrecht, the NetherlandsDepartment of Pediatric Infectious Diseases and Immunology, Wilhelmina Children’s hospital, UMC Utrecht, Utrecht, the NetherlandsHematopoietic Stem Cell Transplantation, Princess Maxima Center for Pediatric Oncology, Utrecht, the NetherlandsDepartment of pediatrics, Memorial Sloan Kettering Cancer Center, New York, United States of AmericaHematopoietic Stem Cell Transplantation, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children’s hospital, UMC Utrecht, Utrecht, the NetherlandsDepartment of Pediatric Infectious Diseases and Immunology, Wilhelmina Children’s hospital, UMC Utrecht, Utrecht, the Netherlands; Correspondence to: Wilhelmina Children’s Hospital, Postbus 85090, Utrecht 3508AB, the Netherlands.Background: Azoles are recommended as antifungal prophylaxis in decreasing the incidence of invasive fungal disease (IFD) in high-risk patients in pediatric oncology, including patients receiving allogeneic hematopoietic cell transplantation (HCT). However, azole related toxicity, pharmacological interactions with immunosuppressive medication and conditioning regimen and growing incidence of azole resistance makes this antifungal agent not ideal in the transplant setting. This study reports on the contemporary incidence and outcome of IFD after allogeneic HCT in children with prophylactic liposomal amphotericin B (L-AMB). Methods: This single-center retrospective study included all patients transplanted between 2012 and 2022. Primary endpoint was the incidence of IFD until hospital discharge post-transplant. Secondary aims were the incidence of IFD and survival 180 days after allogeneic HCT, the evaluation of toxicity of L-AMB and further risk factors for development of IFD during antifungal prophylaxis. Descriptive statistics were performed. Results: 161 pediatric patients received L-AMB. Incidence of breakthrough IFD post-transplant was 7.5 % (12/161). The 12 cases comprised of three invasive yeast infections (1.9 %), three probable (1.9 %) and six possible (3.7 %) mold infections. Adverse events were in 22.4 % of the patients, most of them mild and reversible. Discontinuation of L-AMB occurred in 2.5 % (4/161) of the patients due to severe hypersensitivity reactions. Conclusions: The risk of breakthrough IFD in pediatric patients undergoing allogeneic HCT under L-AMB prophylaxis is comparable with the reported risk under first line recommendation drugs for antifungal prophylaxis. If no hypersensitivity reaction occurs, L-AMB is tolerated with manageable side effects. This antifungal agent should therefore be considered as an alternative option to azoles in pediatric allogeneic HCT recipients.http://www.sciencedirect.com/science/article/pii/S2772610X24000345Invasive fungal diseaseHematopoietic cell transplantationAllogeneicLiposomal amphotericin B |
| spellingShingle | Laura G.Y. Rotte Coco C.H. de Koning Yvette G.T. Loeffen Marc B. Bierings Jaap Jan Boelens Caroline A. Lindemans Tom F.W. Wolfs Prophylactic use of liposomal amphotericin B in children and adolescents undergoing allogeneic hematopoietic cell transplantation: A 10-years single center experience EJC Paediatric Oncology Invasive fungal disease Hematopoietic cell transplantation Allogeneic Liposomal amphotericin B |
| title | Prophylactic use of liposomal amphotericin B in children and adolescents undergoing allogeneic hematopoietic cell transplantation: A 10-years single center experience |
| title_full | Prophylactic use of liposomal amphotericin B in children and adolescents undergoing allogeneic hematopoietic cell transplantation: A 10-years single center experience |
| title_fullStr | Prophylactic use of liposomal amphotericin B in children and adolescents undergoing allogeneic hematopoietic cell transplantation: A 10-years single center experience |
| title_full_unstemmed | Prophylactic use of liposomal amphotericin B in children and adolescents undergoing allogeneic hematopoietic cell transplantation: A 10-years single center experience |
| title_short | Prophylactic use of liposomal amphotericin B in children and adolescents undergoing allogeneic hematopoietic cell transplantation: A 10-years single center experience |
| title_sort | prophylactic use of liposomal amphotericin b in children and adolescents undergoing allogeneic hematopoietic cell transplantation a 10 years single center experience |
| topic | Invasive fungal disease Hematopoietic cell transplantation Allogeneic Liposomal amphotericin B |
| url | http://www.sciencedirect.com/science/article/pii/S2772610X24000345 |
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