Invasive Fungal Disease Among Pediatric and Adolescent Patients Undergoing Itraconazole Prophylaxis After Hematopoietic Stem Cell Transplantation |
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| Institution: | 1. Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;2. Department of Pediatrics, Uttaradit Hospital, Uttaradit, Thailand;3. Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;1. Nephrology and Kidney Transplantation Clinic, Laiko Hospital, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece;2. Pneumonology Department, Laiko Hospital, Athens, Greece;1. Department of Pediatric Surgery, Tohoku University School of Medicine, Sendai, Japan;2. Department of Pediatric Surgery, Miyagi Children''s Hospital, Sendai, Japan;3. Department of Pediatric Surgery, Iwate Prefectural Central Hospital, Morioka, Japan;1. Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea;2. Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, Daegu, South Korea;3. Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea;1. Department of Histology, Institute of Medical Sciences, University of Opole, Opole, Poland;2. Department of Pneumonology and Allergology, Medical University of Gdansk, Gdańsk, Poland;3. Department of Cardiac Surgery and Vascular Surgery, Medical University of Gdansk, Gdańsk, Poland;4. Medical University of Gdansk, Gdańsk, Poland;5. Department of Pathomorphology, Medical University of Gdansk, Gdańsk, Poland;6. Department of Radiology, Medical University of Gdansk, Gdańsk, Poland;1. Department of Thoracic Surgery, Kawasaki Medical School Hospital, Okayama, Japan;2. Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan;3. Organ Transplant Center, Okayama University Hospital, Okayama, Japan;1. Transplantation Directorate, Hungarian National Blood Transfusion Service, Budapest, Hungary;2. Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary;3. Pediatric Heart Center, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary;4. Institute of Surgery, University of Debrecen Medical and Health Science Center, Debrecen, Hungary;5. Thoracic Surgery Clinic, Semmelweis University, Budapest, Hungary;6. Heart and Vascular Center, Semmelweis University, Budapest, Hungary;7. Department of Surgery, University of Pécs, Pécs, Hungary;8. Department of Surgery, University of Szeged, Szeged, Hungary;9. Research and Development Directorate, Hungarian National Blood Transfusion Service, Budapest, Hungary;10. Transplantation Immunogenetics Laboratory, Hungarian National Blood Transfusion Service, Budapest, Hungary |
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| Abstract: | BackgroundInvasive fungal disease (IFD) is a major cause of morbidity and mortality in patients after hematopoietic stem cell transplantation (HSCT). Itraconazole has been used for prevention of IFD, but data related to incidence and associated factors of IFD in pediatric and adolescent patients on itraconazole prophylaxis remain scarce.ObjectivesTo identify incidence and risk factors associated with IFD among pediatric and adolescent patients receiving itraconazole prophylaxis after HSCT.MethodsPatients younger than 21 years who received itraconazole prophylaxis after HSCT from January 2007 to December 2016 were retrospectively enrolled. Incidence of IFD within 1 year and associated factors were analyzed.ResultsAll patients received itraconazole during the pre-engraftment period. Of 170 patients, 29 had IFD, with an incidence of 17.1% at 1 year. IFD at 1 year was significantly associated with increased mortality. Of 29 patients with IFD, only 9 developed IFD while on itraconazole prophylaxis (5.3%), all of whom had invasive pulmonary aspergillosis. No invasive candidiasis occurred during itraconazole prophylaxis. Prolonged neutropenia (hazard ratio HR] = 1.08; 95% confidence interval CI], 1.02-1.13), graft-versus-host disease within 100 days after transplantation (HR = 3.17; 95% CI, 1.17-8.57), and using etoposide in preconditioning regimens (HR = 21.60; 95% CI, 2.44-190.95) were significantly associated with IFD at 1 year. No patients had to discontinue itraconazole because of its adverse effects.ConclusionsItraconazole proffered good efficacy for prevention of candidiasis during the pre-engraftment period. Most IFD episodes occurred after the engraftment period when itraconazole had been discontinued. During this period, patients with risk factors require appropriate fungal prophylaxis. |
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