Safety and Efficacy of a Caspofungin-based Combination Therapy for the Treatment of Invasive Mycoses in Pediatric Hematological Patients

S. Cesaro*, M. SpiLLer, M. Giacchino, B. BuLdini, C. CasteLLini, D. CaseLLi, E. GiraLdi, E Tucci, G. TrideLLo, E LocateLLi, M.R. Rossi, E. CastagnoLa

Author address: 

Clinic of Pediatric Hematology Oncology, Department of Pediatrics, University of Padua, Italy, Pediatric Oncolosy Hematolosy, Resina Elena Hospital, University of Turin, Italy, pediatric Hematology Oncology Unit, IRCCS Policlinico San Matteo,

Abstract: 

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.
2006

abstract No: 

S105

Full conference title: 

14th International Symposium of Infections in the Immunocompromised Host
    • ISIIH, 14th