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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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.
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