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Liposomal amphotericin B prophylaxis of invasive mold infections in children post allogeneic stem cell transplantation
Author(s) -
Roman Elizabeth,
Osunkwo Ifeyinwa,
Militano Olga,
Cooney Erin,
van de Ven Carmella,
Cairo Mitchell S.
Publication year - 2008
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.21239
Subject(s) - medicine , surgery , graft versus host disease , transplantation , fluconazole , cumulative incidence , incidence (geometry) , hematopoietic stem cell transplantation , gastroenterology , antifungal , physics , dermatology , optics
Background Invasive mold infections (IMI) are a leading cause of infectious mortality in allogeneic stem cell transplant (AlloSCT) recipients. Fluconazole, the current standard for fungal prophylaxis, is ineffective against molds. We initiated a pilot study to determine the safety and activity of prophylactic liposomal amphotericin B (AMB) in preventing IMI in pediatric and adolescent AlloSCT recipients during the first 100 days. Procedure Fifty‐one patients (57 AlloSCT) were given AMB (3 mg/kg/day) intravenously, day 0–100. Median age 6 years, 32 males, 19 females. Donors: 33 unrelated and 2 related cord blood, 13 related and 1 unrelated peripheral blood stem cell and 8 related bone marrow (BM); 30 received myeloablative and 27 reduced intensity conditioning. Graft‐versus‐host disease (GVHD) prophylaxis comprised tacrolimus and mycophenolate mofetil. Results Median follow‐up is 557 days. AMB was generally well tolerated. The probability of developing ≥grade II acute GVHD and extensive chronic GVHD was 45% and 7%, respectively. Estimated 1‐year OS is 62.4% for all patients with 78.8% and 26.7% for average‐risk and poor‐risk, respectively. The incidence of IMI was 0%. Conclusions These results suggest prophylactic AMB is tolerable and may prevent IMI, especially Aspergillus , during the first 100 days post AlloSCT in pediatric and adolescent patients. A randomized study is needed to determine the efficacy of this approach. Pediatr Blood Cancer 2008;50:325–330. © 2007 Wiley‐Liss, Inc.