Voriconazole for invasive aspergillosis in oncohematological patients: a single-center pediatric experience.
Voriconazole is a new triazole active orally and parenterally that recently proved effective in the treatment of invasive aspergillosis and in empirical antifungal therapy for persistently febrile neutropenic patients. Limited data are available for pediatric patients. We report our experience with voriconazole in seven children with invasive aspergillosis, i.e., four girls and three boys with a median age of 5 (range 2-13) years affected by acute lymphoblastic leukemia (3), acute myeloid leukemia (2), refractory anemia with excess of blasts (1), and severe aplastic anemia (1). First-line therapy in all patients was liposomal amphotericin B (AmBisome) administered at a dosage of 3-5 mg/kg day. Voriconazole was administered for a median 8 (range 2-15) weeks. Response was complete and partial in two patients, respectively, stable in one, and there was no response (failure) in two. The voriconazole treatment was well tolerated. Four patients died-two of progressive aspergillosis. Three patients are alive and well 6, 5, and 4 months after the diagnosis of aspergillosis. Voriconazole appears to be an effective salvage treatment for invasive aspergillosis in pediatric patients, with good responses in patients who recover from neutropenia or are not relapsing.
D000293:Adolescent; D000666:Amphotericin B / Q000008:administration & dosage; D000741:Anemia, Aplastic / Q000188:drug therapy; D000753:Anemia, Refractory / Q000188:drug therapy; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000494:pharmacology; D000970:Antineoplastic Agents / Q000009:adverse effects; D001228:Aspergillosis / Q000188:drug therapy* / Q000209:etiology*; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D019337:Hematologic Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D015479:Leukemia, Myelomonocytic, Acute / Q000188:drug therapy; D008297:Male; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy; D011743:Pyrimidines / Q000008:administration & dosage* / Q000494:pharmacology; D013997:Time Factors; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage* / Q000494:pharmacology; D065819:Voriconazole
D000935:Antifungal Agents; D000970:Antineoplastic Agents; D011743:Pyrimidines; D014230:Triazoles; D000666:Amphotericin B; D065819:Voriconazole