Pana Zoi Dorothea, Kourti Maria, Vikelouda Katerina, Vlahou Antonia, Katzilakis Nikolaos, Papageorgiou Maria, Doganis Dimitrios, Petrikkos Loizos, Paisiou Anna, Koliouskas Dimitrios, Kattamis Antonios, Stiakaki Eftichia, Chatzistilianou Maria, Vasilatou-Kosmidis Helen, Polychronopoulou Sophia, Grafakos Stelios, Roilides Emmanuel
Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences.
Hematology/Oncology Unit, 2nd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, AHEPA General Hospital, Thessaloniki.
J Pediatr Hematol Oncol. 2018 Jan;40(1):22-26. doi: 10.1097/MPH.0000000000000926.
Antifungal prophylaxis (AFP) is recommended in at-risk hematology-oncology patients. We evaluated the safety of AFP with voriconazole (VRC) in pediatric hematology/oncology patients.
A retrospective study of VRC AFP in children with malignancies hospitalized in all 7 Greek pediatric hematology/oncology centers during 2008 to 2012 was conducted. Patients' demographics, outcome, and adverse event (AE) data were recorded.
Four hundred twenty-nine VRC AFP courses in 249 patients (median age 6 y, 55% boys) were studied. The most common underlying diseases were acute lymphoblastic leukemia (51%), non Hodgkin lymphoma (8.6%), and acute myeloid leukemia (7.7%). The median number of VRC courses per patient was 1.7, whereas the median VRC dose was 7 mg/kg (range, 5 to 7 mg/kg) every 12 hours. During the last 2 weeks before AFP, 51% of the patients had received corticosteroids, 43% suffered from severe neutropenia, and 17.3% from mucositis. The median duration of VRC AFP was 17 days (range, 1 to 31 d). A single breakthrough fungemia due to Candida glabrata was recorded. Only 1 patient died due to the underlying disease. The most common AEs reported in 70/429 (16.3%) courses with ≥1 AE were elevated liver enzymes (50%), hypokalemia (24.3%), and ophthalmological disorders (14.3%). The median time of AE onset was 5 days (range, 1 to 21 d). Among 70 AEs reported, 38.5%, 48.4%, and 12.8% were of grade I, II, and III, respectively.
VRC prophylaxis in pediatric hematology/oncology patients appears to be well tolerated.
对于有风险的血液肿瘤学患者，推荐进行抗真菌预防（AFP）。我们评估了伏立康唑（VRC）用于儿科血液学/肿瘤学患者AFP的安全性。
对2008年至2012年期间在希腊所有7家儿科血液学/肿瘤学中心住院的恶性肿瘤患儿进行VRC AFP的回顾性研究。记录患者的人口统计学资料、结局和不良事件（AE）数据。
研究了249例患者（中位年龄6岁，55%为男孩）的429个VRC AFP疗程。最常见的基础疾病为急性淋巴细胞白血病（51%）、非霍奇金淋巴瘤（8.6%）和急性髓细胞白血病（7.7%）。每位患者VRC疗程的中位数为1.7，而VRC剂量中位数为每12小时7mg/kg（范围为5至7mg/kg）。在AFP前的最后2周内，51%的患者接受了皮质类固醇治疗，43%的患者患有严重中性粒细胞减少症，17.3%的患者患有口腔炎。VRC AFP的中位持续时间为17天（范围为1至31天）。记录到1例由光滑念珠菌引起的突破性真菌血症。仅1例患者因基础疾病死亡。在429个疗程中有70个（16.3%）报告了≥1种AE，最常见的AE为肝酶升高（50%）、低钾血症（24.3%）和眼科疾病（14.3%）。AE发生的中位时间为5天（范围为1至21天）。在报告的70例AE中，分别有38.5%、48.4%和12.8%为Ⅰ级、Ⅱ级和Ⅲ级。
儿科血液学/肿瘤学患者使用VRC预防似乎耐受性良好。
