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Microbial Issues

Voriconazole as primary antifungal prophylaxis in children undergoing allo-SCT

Bone Marrow Transplantation volume 47, pages 562–567 (2012)Cite this article

Abstract

Invasive fungal disease (IFD) causes significant morbidity and mortality among children undergoing allo-SCT. In this prospective pilot study, we analyze voriconazole as primary antifungal prophylaxis. From October 2004 to July 2010, 56 children <18 years of age were enrolled in this study. Patients received voriconazole doses of 5 mg/kg per 12 h (n=23) or 7 mg/kg per 12 h (n=33), with a limiting dose of 200 mg/12 h, from day −1 to day +75 or later in patients with active acute GVHD. Patients were followed up for IFD for 6 months. In this series, 37 (66.1%) patients successfully completed treatment (85.7% during neutropenic period) without empirical or preemptive antifungal therapy, adverse effects or IFD. Nine (16.1%) children needed preemptive (n=2) or empirical (n=7) antifungal therapy, and one (1.8%) of them developed a fatal probable IFD during the study period. A total of 10 (17.8%) children developed adverse effects related to voriconazole prophylaxis, leading to definitive withdrawal on median day 26.5 (in 7 patients after granulocytic recovery). The most frequent adverse effect was persistent elevation of hepatic enzymes in seven (12.5%) children. There were no differences between doses of 5 and 7 mg/kg per 12 h. Our results suggest that voriconazole can be safely used as primary antifungal prophylaxis in children undergoing allo-SCT.

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Acknowledgements

This study was supported by Asociacion Medicina e Investigación (AMI).

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Authors and Affiliations

  1. Department of Hematology, Bone Marrow Transplantation Unit, and Instituto Maimonides Investigación Biomédica (IMIBIC), University Hospital ‘Reina Sofia’, Cordoba, Spain

    J R Molina, J Serrano, J Sánchez-García, A Rodríguez-Villa, P Gómez, D Tallón, V Martín, G Rodríguez, R Rojas, C Martín, F Martínez, M A Álvarez & A Torres

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  1. J R Molina
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Correspondence to J R Molina.

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Competing interests

JR Molina has received honoraria for speaking at medical education events supported by Gilead Science and Pfizer. R Rojas has received honoraria for speaking at symposia organized by Gilead Science and Merck Sharp and Dohme (MSD). A Torres has received honoraria for participation as a speaker at a medical education event and symposia supported by Gilead, Pfizer and MSD. All the other authors declare no conflicts of interest.

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Molina, J., Serrano, J., Sánchez-García, J. et al. Voriconazole as primary antifungal prophylaxis in children undergoing allo-SCT. Bone Marrow Transplant 47, 562–567 (2012). https://doi.org/10.1038/bmt.2011.111

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