Voriconazole in the treatment of children with acute lymphoblastic leukemia and invasive aspergillosis: how long should we treat?

Ref ID: 19422

Author:

J. Van der Werff ten Bosch, R. M. Oostveen, A. de Bel and
M. Van den Akker

Author address:

UZ Brussel, Belgium

Full conference title:

6th Trends in Medical Mycology 2013

Date: 11 October 2014

Abstract:

Introduction Between Juli 2010 and December 2012, 8 pediatric
patients with acute lymphoblastic leukemia (ALL) were diagnosed
with invasive aspergillosis during induction therapy. Although the
diagnostic criteria and treatment strategies for invasive aspergillosis
are clear, data lack on how long the treatment should be continued
or how the infection and response to therapy should be monitored. Data 3/8 patients had proven, 4/8 probable and 1/8 possible dis-
ease. All patients were treated with Voriconazole, initially intrave-
nously and afterwards orally. One patient underwent a lobectomy
because a cavernous lesion.
We used imaging studies as the main tool to evaluate the response
till disappearance of the lesions or in case of clinical signs. Vori-
conazol levels were measured weekly.
Findings Voriconazol dosage was aimed to obtain through levels
between 2 an 6 mg/L but most patients had levels below the lower
limit throughout the treatment, notwithstanding adjustment of the
dose. The treatment was continued in all patients until the start of
maintenance therapy. One patient suffered a relapse while treated
with oral Voriconazole.
Conclusion We treated 8 pediatric patients with Voriconazole for
invasive aspergillus. It was difficult to maintain good Voriconazole
trough levels, but nevertheless only one patient suffered a relapse.
No conclusions can be drawn concerning the duration of the treat-
ment, but the fact that 1 patient relapsed indicates that the treat-
ment should be continued at least for several months and careful
monitoring should be continued, even after cessation of therapy.

Abstract Number: p194

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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