Secondary prophylaxis of invasive fungal infections with combination antifungal therapy and G-CSF-mobilized granulocyte transfusions in three children with hematological malignancies.
Fungal infections represent a life-threatening complication for patients receiving chemotherapy or undergoing hematopoietic stem cell transplantation. Historically, antifungal monotherapy is associated with a poor outcome. We treated three children with hematological malignancies and proven fungal infections (one cerebral mold infection, one disseminated Candida infection, one naso-pharyngeal mucor infection) with combination antifungal therapy plus granulocyte-colony-stimulation-factor-mobilized granulocyte transfusions as secondary prophylaxis during subsequent neutropenic episodes. With this approach, the fungal infection was effectively treated, and the anticancer therapy was completed without major delay. All children survived the fungal infection and the underlying malignancy. These experiences illustrate the feasibility of this approach using more than one antifungal agent together with immune-therapy in high-risk patients.
Department of Paediatric Haematology and Oncology, Medizinische Hochschule Hannover, OE 6780, Carl-Neuberg Str. 1, D-30625 Hannover, Germany. Grigull.Lorenz@mh-hannover.de
Lorenz
L
Grigull
Andreas
A
Beilken
Hansjoerg
H
Schmid
P
P
Kirschner
Karl-Walter
KW
Sykora
Christin
C
Linderkamp
Frank
F
Donnerstag
Lilia
L
Goudeva
Hans-Gert
HG
Heuft
Karl
K
Welte
D000293:Adolescent; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000517:prevention & control; D002177:Candidiasis / Q000517:prevention & control; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006098:Granulocytes; D019337:Hematologic Neoplasms / Q000188:drug therapy / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D017708:Leukocyte Transfusion; D008297:Male; D009091:Mucormycosis / Q000517:prevention & control; D009181:Mycoses / Q000209:etiology / Q000517:prevention & control*; D009190:Myelodysplastic Syndromes / Q000628:therapy; D009503:Neutropenia / Q000150:complications / Q000209:etiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy
D000935:Antifungal Agents; D016179:Granulocyte Colony-Stimulating Factor