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A prospective, randomized study of empirical antifungal therapy for the treatment of chemotherapy‐induced febrile neutropenia in children
Author(s) -
Caselli Désirée,
Cesaro Simone,
Ziino Ottavio,
Ragusa Pietro,
Pontillo Alfredo,
Pegoraro Anna,
Santoro Nicola,
Zanazzo Giulio,
Poggi Vincenzo,
Giacchino Mareva,
Livadiotti Susanna,
Melchionda Fraia,
Chiodi Marcello,
Aricò Maurizio
Publication year - 2012
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2012.09156.x
Subject(s) - neutropenia , medicine , febrile neutropenia , caspofungin , randomized controlled trial , mycosis , confidence interval , chemotherapy , surgery , antifungal , amphotericin b , dermatology
Summary Given that the rationale for empirical antifungal therapy in neutropenic children is limited and based on adult patient data, we performed a prospective, randomized, controlled trial that evaluated 110 neutropenic children with persistent fever. Those at high risk for invasive fungal infections ( IFI ) received caspofungin ( A rm C ) or liposomal amphotericin B ( A rm B ); those with a lower risk were randomized to receive A rm B , C , or no antifungal treatment ( A rm A ). Complete response to empirical antifungal therapy was achieved in 90/104 patients (86·5%): 48/56 at high risk (85·7%) [88·0% in A rm B ; 83·9% in A rm C ( P = 0·72)], and 42/48 at low risk (87·5%) [87·5% in control A rm A , 80·0% A rm B , 94·1% A rm C ; ( P = 0·41)]. None of the variables tested by multiple logistic regression analysis showed a significant effect on the probability to achieve complete response. IFI was diagnosed in nine patients (8·2%, 95% confidence interval, 3·8–15·0). This randomized controlled study showed that empirical antifungal therapy was of no advantage in terms of survival without fever and IFI in patients aged <18 years and defined with low risk of IFI . Higher risk patients, including those with relapsed cancer, appear to be the target for empirical antifungal therapy during protracted febrile neutropenia.