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 7.46x10 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.
Full conference title:
Annual Meeting of the EBMT, 37th
- EBMT 37th (2011)