P882 Effectiveness and safety of voriconazole in primary antifungal prophylaxis for children undergone allogeneic stem cell transplantation

Ref ID: 18592

Author:

D. Tallon, J.R. Molina, J. Serrano, P. Gomez, A. RodriguezVilla, C. Cerrato, A. Torres

Author address:

University Hospital Reina Sofi a (Cordoba, ES)

Full conference title:

Annual Meeting of the EBMT, 36th

Abstract:

Introduction: Invasive fungal infection (IFI) incur signifi cant
morbidity and mortality among children undergone Allogeneic
Stem Cell Transplantation (Allo-SCT) due to neutropenic phase
and posterior immunosuppression. We have analyzed in this
prospective study our experience in pediatric patients who
received voriconazole as primary antifungal prophylaxis undergone Allo-SCT.
Methods and patients: A total of 50 children and adolescents
< 18 years were enrolled in this study from Oct-2004 to May- 2009, median age was 9 years (range: 1-17). All patients received voriconazole at a dose of 5 mg/kg/12 hours (n = 23) or 7 mg/kg/12 hours (n = 28) until a highest dose of 200 mg/12 hours, from day -1 to day + 75 or later in patients with acute graft versus host disease (aGVHD). Patients were followed up for six months from Allo-SCT. IFI (proven or probable) was diagnosed according to EORTC/MSG criteria. Results: Only one (2%) patient developed IFI (Proven Aspergillosis) while prophylaxis with voriconazole and died due to it. In this series 32 (64%) patients completed successfully the treatment without adverse effects, no empirical or preemptive antifungal therapy neither IFI, in 29 of these 32 patients voriconazole was stopped on day + 75, in the rest 3 children, due to aGVHD, it was maintained until a mean day + 145. A total of 9 (18%) receptors needed an empirical (n = 7) or preemptive (n = 2) antifungal therapy, voriconazole was stopped and replaced with amphotericin B in patients under 14 years (n = 6) or caspofungine in patients between 14 and 17 years (n = 3) during neutropenia period. In 10 (20%) children was detected adverse effect due to voriconazole prophylaxis and needed a defi nitive withdrawal. The most frequently adverse effects due to this azole was persistent hepatic damage with cytolysis enzymes elevation > 2.5 basal levels in 7 (14%) children. Skin
rash (n = 1), pancreatitis (n = 1) and tremor (n = 1) were the others secondary effects observed. All adverse effects were solved
once stopped voriconazole.
Conclusion: With an overall IFI incidence of 2%, our results
suggest that primary antifungal prophylaxis in children undergone Allo-SCT with voriconazole is effective at reducing the
incidence of IFI in this type of high risk pediatric patients. Voriconazole is well tolerated despite a high percentage of adverse
effects easily solved by drug stopped without life-threatening
complications.

Abstract Number: P882

Conference Year: 2010

Link to conference website: NULL

New link: NULL

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