Introduction: Data on the use of caspofungin in combination with other systemic antifunga[ drugs for pediatric patients are scanty. Methods: A prospective study was performed from November 2002 to November 2005 to investigate the safety and efficacy of caspofungin-based combination therapy in children and adolescents. Results: Sixty-six patients were recruited with a median age at diagnosis of 11.3 years; most of them were affected by an underlying malignant disease. Twenty-one (32%) patients developed an invasive funga[ infection (IFI) after hematopoietic stem ceLL transplantation, 22 after primary diagnosis, and 23 after relapse. Severe neutropenia was present in 52 (79%) patients. The mycoses were classified as possible in 17 (26%), probable in 20 (30%) and documented in 29 (44%) patients, respectively. A favorable response to antifunga[ therapy was obtained in 37 patients (56%) and the probability of 100-day survival was 72%. OveraLL, the combination therapy was weLL tolerated. After a median foLLow-up of 1.2 years, 31 patients were alive (47%). The probability of overaLL survival LOS) was significantly different for mycosis diagnosed after relapse, 20.9%, after HSCT, 32.4%, and after primary diagnosis, 48%, p 0.007. In a multivariate analysis, underlying disease status was the factor associated with favorable response, whilst factors associated with 100-day survival were the duration of therapy with caspofungin and the achievement of a favorable response; and those associated with OS were the occurrence of IFI after primary diagnosis, use of surgery, and the achievement of a favorable response. Conclusion: This study showed that caspofunginbased combination antifunga[ therapy is an efficacious therapeutic option for pediatric patients with invasive mycoses. These data need to be confirmed by prospective controLLed studies.
Full conference title:
14th International Symposium of Infections in the Immunocompromised Host
- ISIIH, 14th