期刊
PEDIATRIC BLOOD & CANCER
卷 50, 期 2, 页码 325-330出版社
WILEY
DOI: 10.1002/pbc.21239
关键词
AlloSCT; liposomal amphotericin B; mold prophylaxis; pediatrics
资金
- NHLBI NIH HHS [T32 HL07968] Funding Source: Medline
- NIAMS NIH HHS [AR49330] Funding Source: Medline
- NICHD NIH HHS [5K12HD43389-02] Funding Source: Medline
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 stern 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;50:325330. (c) 2007 Wiley-Liss, Inc.
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