title: A rescue therapy with a combination of caspofungin and liposomal amphotericin B or voriconazole in children with haematological malignancy and refractory invasive fungal infections.
abstract: Combination treatment of paediatric invasive fungal infections (IFIs) has rarely been reported. A total of 17 children with 19 IFI episodes were enrolled in the study. The median age of the patients was 5.3 (range 0.5-17) years. IFI was classified as proven in 4, probable in 12 and possible in 3 episodes. These patients received empiric antifungal treatment, which consisted of liposomal amphotericin B (LAmB) monotherapy for a median duration of 12 days (range 3-69 days). All patients were refractory to LAmB; therefore, caspofungin was added to the therapy in 11 patients. In the remaining six patients, LAmB was ceased and a combination of caspofungin and voriconazole was started. Among the patients who received caspofungin + LAmB, four did not show favourable response and the combination was switched to caspofungin + voriconazole. The median (range) and total duration of the therapy were 7 (3-14) days and 91 patient days for LAmB + caspofungin combination and 49 (7-126) days and 516 patient days for caspofungin + voriconazole combination. We found a favourable response rate of 68.4% in 16 proven or probable IFI episodes. Twelve-week survival rate of these patients was 75%. No serious side effect was observed among the patients. Our data suggest that combination antifungal therapy is safe and effective in children with haematological malignancies.
authors.affiliation: Pediatric Hematology Department, Ege University School of Medicine, Izmir, Turkey. dyilmazk@yahoo.com
authors.forename: Deniz
authors.initials: D
authors.lastname: Yilmaz
authors.forename: Can
authors.initials: C
authors.lastname: Balkan
authors.forename: Yilmaz
authors.initials: Y
authors.lastname: Ay
authors.forename: Mehmet
authors.initials: M
authors.lastname: Akin
authors.forename: Bulent
authors.initials: B
authors.lastname: Karapinar
authors.forename: Kaan
authors.initials: K
authors.lastname: Kavakli
mesh_terms: D000293:Adolescent; D000666:Amphotericin B / Q000008:administration & dosage* / Q000009:adverse effects; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects; D000077336:Caspofungin; D002648:Child; D002675:Child, Preschool; D025141:Drug Resistance, Fungal; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000379:methods; D054714:Echinocandins / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005658:Fungi / Q000187:drug effects; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D007223:Infant; D055666:Lipopeptides; D008297:Male; D009181:Mycoses / Q000188:drug therapy*; D011743:Pyrimidines / Q000008:administration & dosage* / Q000009:adverse effects; D016879:Salvage Therapy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage* / Q000009:adverse effects; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D011743:Pyrimidines; D014230:Triazoles; C068538:liposomal amphotericin B; D000666:Amphotericin B; D000077336:Caspofungin; D065819:Voriconazole