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소아 급성골수성백혈병에서 관해유도 요법 중 Posaconazole의 예방적 항진균 치료

Posaconazole for Prophylaxis of Fungal Infection in Pediatric Patients with Acute Myeloid Leukemia undergoing Induction Chemotherapy

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초록

Background: Posaconazole is a broad-spectrum triazole antifungal agent and the most recommended prophylactic antifungal agentfor patients with acute myeloid leukemia (AML) undergoing induction chemotherapy. In this study, we evaluated the status andeffectiveness of posaconazole as a prophylactic antifungal agent in pediatric patients receiving induction chemotherapy for AML. Methods: We retrospectively reviewed the electronic medical records of 36 pediatric patients with AML (between January 2013 andSeptember 2017) at the Yonsei University Health System. Invasive fungal disease (IFD) was assessed as the primary endpoint ofprophylactic antifungal effect. The secondary endpoints were incidence of fever, persistent fever despite the use of broadspectrumantibiotics for 72 h, alteration of antifungal agent, intensive care unit admission, and death within 100 days. Results:Among the 36 patients, 18 patients used posaconazole, 12 were treated with suspension formula, and 6 of them were treated withtablets. Eighteen patients did not use antifungal agents prophylactically. The mean number of days of posaconazole administrationwas 26.8±16 days. IFD occurred in 2/18 (11.1%) patients in the no prophylaxis group and in 1/18 (5.6%) patients in the posaconazolegroup (p=0.49). Conclusion: Posaconazole is expected to be useful for the prevention of IFD in pediatric patients with AMLundergoing induction chemotherapy. Prospective studies of the effectiveness of posaconazole prophylaxis should be conducted inmore pediatric patients in the future.

Abstract

Background: Posaconazole is a broad-spectrum triazole antifungal agent and the most recommended prophylactic antifungal agentfor patients with acute myeloid leukemia (AML) undergoing induction chemotherapy. In this study, we evaluated the status andeffectiveness of posaconazole as a prophylactic antifungal agent in pediatric patients receiving induction chemotherapy for AML. Methods: We retrospectively reviewed the electronic medical records of 36 pediatric patients with AML (between January 2013 andSeptember 2017) at the Yonsei University Health System. Invasive fungal disease (IFD) was assessed as the primary endpoint ofprophylactic antifungal effect. The secondary endpoints were incidence of fever, persistent fever despite the use of broadspectrumantibiotics for 72 h, alteration of antifungal agent, intensive care unit admission, and death within 100 days. Results:Among the 36 patients, 18 patients used posaconazole, 12 were treated with suspension formula, and 6 of them were treated withtablets. Eighteen patients did not use antifungal agents prophylactically. The mean number of days of posaconazole administrationwas 26.8±16 days. IFD occurred in 2/18 (11.1%) patients in the no prophylaxis group and in 1/18 (5.6%) patients in the posaconazolegroup (p=0.49). Conclusion: Posaconazole is expected to be useful for the prevention of IFD in pediatric patients with AMLundergoing induction chemotherapy. Prospective studies of the effectiveness of posaconazole prophylaxis should be conducted inmore pediatric patients in the future.

참고문헌 (18)

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관련 논문AI추천

발열을 동반한 호중구감소 상태의 급성백혈병 환아에서 경험적 항진균제로 투여한 Amphotericin B와 Itraconazole의 효과와 이상 반응 비교김선영, 김학기, 박경덕, 박종선, 양금진, 이상윤대한소아감염학회 · Pediatric Infection and Vaccine2005 · 제12권 제1호Efficacy of Itraconazole Prophylaxis for Autologous Stem Cell Transplantation in Children with High-Risk Solid Tumors: A Prospective Double-Blind Randomized Study구홍회, 김주연, 유건희, 이수현, 임수진, 정신한, 조은주, 주희원, 최영배, 황혜숙, Ki Woong Sung, Yae-Jean Kim연세대학교의과대학 · Yonsei Medical Journal2011 · 제52권 제2호소아환자의 약물혈중농도 모니터링을 통한 Voriconazole 용량 조절 분석김재송, 손은선, 신다은, 안진서, 장민정한국병원약사회 · 병원약사회지2020 · 제37권 제4호새로운 항진균제 도입 이후 호중구감소증 발열 환자의 경험적 항진균요법과 침습적 진균감염의 연구김태형, 이은정, 전민혁, 추은주대한의진균학회 · 대한의진균학회지2009 · 제14권 제4호Outcome of Intensive Therapy for Children with Relapsed Acute Myeloid Leukemia: A Single Institution Korean Study조빈, 김성구, 유재원, 이재욱, 장필상, 정낙균대한암학회 · Cancer Research and Treatment2022 · 제54권 제4호Comparison of Plasma Concentrations of Posaconazole with the Oral Suspension and Tablet in Korean Patients with Hematologic Malignancies고영일, 김남중, 김의석, 김인호, 김홍빈, 박상인, 박완범, 방수미, 서현정, 송경호, 송상훈, 오명돈, 유경상, 윤서현, 이정옥, 조주연, 최평균대한감염학회 · Infection and Chemotherapy2017 · 제49권 제2호

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