Purpose

To assess and compare the efficacy and safety of posaconazole with fluconazole for the prevention of invasive fungal infections in children who were undergoing induction therapy for acute lymphoblastic leukemia (ALL). To develop an approach to predict invasive fungal infections in ALL patients who accepted posaconazole prophylaxis.

Methods

This was a single-center, retrospective cohort study of patients with newly diagnosed ALL, comparing invasive fungal infections in patients who received no prophylaxis, posaconazole prophylaxis, or fluconazole prophylaxis during induction therapy. A propensity score-weighted logistic regression model was used to adjust for confounders. Hepatotoxicity was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) criteria.

Results

Out of the 155 ALL patients, 60 received no prophylaxis, 70 received posaconazole prophylaxis, and 25 received fluconazole prophylaxis. Posaconazole prophylaxis reduced the odds of invasive fungal infections by > 60%, prolonged infection-free survival significantly, and did not increase the risk of hepatotoxicity. Additionally, we found that the combination of age at diagnosis, clinically documented bacterial infection in the first 15 days of induction therapy, and absolute neutrophil count (ANC) curve enabled significant prediction of the susceptibility to infections after receiving posaconazole prophylaxis.

Conclusions

Our findings supported using targeted prophylaxis with posaconazole in ALL children undergoing induction chemotherapy. Age, clinically documented bacterial infection and ANC are important predictors of invasive fungal infections in patients with posaconazole prophylaxis.

中文翻译：

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儿童急性淋巴细胞白血病诱导治疗期间泊沙康唑和氟康唑的预防

目的

评估和比较泊沙康唑与氟康唑预防接受急性淋巴细胞白血病 (ALL) 诱导治疗的儿童侵袭性真菌感染的有效性和安全性。开发一种方法来预测接受泊沙康唑预防的 ALL 患者的侵袭性真菌感染。

方法

这是一项针对新诊断 ALL 患者的单中心回顾性队列研究，比较了诱导治疗期间未接受预防、泊沙康唑预防或氟康唑预防的患者的侵袭性真菌感染。倾向得分加权逻辑回归模型用于调整混杂因素。根据不良事件通用术语标准 (CTCAE) 标准评估肝毒性。

结果

在 155 名 ALL 患者中，60 名未接受预防，70 名接受泊沙康唑预防，25 名接受氟康唑预防。泊沙康唑预防可将侵袭性真菌感染的几率降低 > 60%，显着延长无感染生存期，并且不会增加肝毒性的风险。此外，我们发现诊断时的年龄、诱导治疗前 15 天临床记录的细菌感染和绝对中性粒细胞计数 (ANC) 曲线的组合能够显着预测接受泊沙康唑预防后感染的易感性。

结论

我们的研究结果支持在所有接受诱导化疗的儿童中使用泊沙康唑进行靶向预防。年龄、临床记录的细菌感染和 ANC 是泊沙康唑预防患者侵袭性真菌感染的重要预测因素。