Antifungal usage in children undergoing intensive treatment for acute myeloid leukemia: analysis of the multicenter clinical trial AML-BFM 93.
We retrospectively analyzed the antifungal usage in children with acute myeloid leukemia (AML). Overall, 211 of 304 patients (69.4%) received a total of 389 antifungal treatment episodes. In 234 episodes, initial antifungal treatment consisted of amphotericin B [as monotherapy, n = 193; median dosage (range) of amphotericin B deoxycholate 0.6 mg/kg per day (0.02-1.5 mg/kg per day) and of liposomal amphotericin B 3.0 mg/kg per day (0.6-30 mg/kg per day)], in 149 episodes of fluconazole [as monotherapy, n = 143; 5 mg/kg per day (1-29 mg/kg per day)], in 40 of flucytosine [as monotherapy, n = 1; 150 mg/kg per day (40-370 mg/kg per day)], and in 9 of itraconazole [as monotherapy, n = 8; 6 mg/kg per day (1.6-20 mg/kg per day)]. We conclude that the majority of children with AML receives at least one episode of antifungal therapy. Inappropriate dosing and combination of antimycotics need to be addressed in future educational measures.
Pediatric Hematology and Oncology, Children's Hospital III, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany. Thomas.Lehrnbecher@kgu.de
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Lehrnbecher
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Kaiser
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Varwig
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Ritter
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Groll
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Creutzig
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Klingebiel
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Schwabe
D000293:Adolescent; D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage*; D001228:Aspergillosis / Q000150:complications* / Q000188:drug therapy*; D002177:Candidiasis / Q000150:complications* / Q000188:drug therapy*; D002648:Child; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage; D005437:Flucytosine / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017964:Itraconazole / Q000008:administration & dosage; D015479:Leukemia, Myelomonocytic, Acute / Q000382:microbiology*; D008297:Male; D012189:Retrospective Studies
D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B; D015725:Fluconazole; D005437:Flucytosine