Background: Invasive Aspergillosis and Candidiasis are some of the major infectious complications after allogeneic hematopoietic stem cell transplantation (HSCT) with an incidence between 10 - 30% and an associated mortality rate between 50 - 90%. Posaconazole is an extended spectrum triazole with clinical activity against Aspergillus spp., Candida spp., Zygomycetes, Fusarium spp. and other rare causes of invasive fungal infections such as Cryptococcus neoformans and Histoplasma capulatum. Due to the excellent results regarding efficacy, safety and feasibility that were shown in prospective studies in adults, we have been using posaconazole for antifungal prophylaxis in pediatric patients for several years now. Bioavailability of posaconazole suspension is impaired by low gastrointestinal resorption due to its lipophilicity. Investigations on adult patients after HSCT have shown that posaconazole resorption depends strongly on the gastric conditions, e.g. intestinal graft-versus-host disease, fat uptake during drug administration, or concomitant medication such as proton pump inhibitors, However, there is insufficient data on the pharmacokinetics of posaconazole in pediatric patients. This single-center analysis evaluated the pharmacokinetic properties as well as efficacy, safety, and feasibility of posaconazole during the initial four weeks of oral antifungal prophylaxis in pediatric and adolescent patients after allogeneic HSCT.
Full conference title:
- ASH 57th (2015)