Liposomal Amphotericin B prophylaxis of invasive fungal infections in children and adolescents undergoing haematopoietic stem cell transplantation

Ref ID: 18609

Author:

P. Sovinz, W. Schwinger, H. Lackner, M. Benesch, V. Strenger,
S. Schmidt, C. Urban

Author address:

Medical University of Graz (Graz, AT)

Full conference title:

Annual Meeting of the EBMT, 37th

Abstract:

Introduction: Antifungal prophylaxis in pediatric and adolescent
patients undergoing hematopoietic stem cell transplantation
(HSCT) is not well standardized. Liposomal Amphotericin B
(LAMB) has a broad antifungal spectrum and a long terminal
elimination half-life allowing intermittent administration.
Patients and methods: In 2009 and 2010, 20 consecutive
patients (median age: 11.4 years; m: f=8:12) underwent 23
HSCT procedures (autologous: 12, including 3 tandem transplants; allogeneic: 11) for solid tumors (7), relapsed severe
aplastic anemia or myelodysplastic syndrome (5), hematologic
malignancies (5), Hurler’s disease (2), and Crohn’s disease (1).
In autologous HSCT recipients, median number of CD34+cells
was 7.46×10
6
/kg; leukocyte engraftment occurred on median
day +9.5. In allogeneic HSCT, stem cell sources were PBSC
(CD34+selected and/or CD3/19 depleted) in 9, BM in 2 patients,
from matched unrelated donors (9), matched sibling donor (1)
and haploidentical parent (1), respectively, containing a median
of 15,37
6
x10 CD34+cells/kg; median day of leukocyte engraftment was +11. Graft versus host disease (GvHD) occurred in
5 patients, of whom one developed GvHD IV (skin+gut). LAMB
prophylaxis was started in 2 patients with refractory AML on
days -46 and -42, respectively, and in the other patients on
median day -3, at a dose of 5 mg/kg at intervals of 3 days (15)
or 2 days (8). Patients received a median of 11.5 prophylactic
doses until median day + 20.5.
Results: Intervals of LAMB administration were shortened in 8
patients during febrile episodes or CRP increase. Intermittent
candida colonization was detected in 9 patients by weekly
surveillance cultures. Galaktomannan testing was performed
weekly and remained negative in 17 patients, 2 patients
had one single positive result each; none of the 19 patients
developed an invasive fungal infection during a median follow-up of 10 months. One patient with refractory AML-relapse
and GvHD IV on multimodal immunosuppression repeatedly
showed positive galaktomannan tests; despite continuous
preemptive antifungal therapy with LAMB alternating with
caspofungin the patient developed aspergillus pneumonia
and died on day +140. LAMB infusions were tolerated well;
main side effect was hypokalemia which had to be substituted
in 20/23 courses.
Conclusions: LAMB prophylaxis was able to prevent invasive
fungal infections in 19/20 pediatric and adolescent recipients of
autologous or allogeneic HSCT with tolerable side effects.

Abstract Number: P608

Conference Year: 2011

Link to conference website: NULL

New link: NULL

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