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Efficacy of Voriconazole Prophylaxis in Pediatric Patients with Acute Myeloid Leukemia, Single Center Experience, Egypt

Youssef Madney, Omar Arafah1, Hader Elmahalawy and Lobna Shalby

Background: Patients with hematologic malignancies are at higher risk for Invasive Fungal Infections (IFI) mainly patients with acute myeloid leukemia. Antifungal prophylaxis can help to decrease the incidence of these infections and their related complications.

Patients and methods: Prospective study compared to historical control data included 136 newly diagnosed Acute Myeloid Leukemia patients treated at the National Cancer Institute, Cairo University from 2011 to 2014. The prospective group received primary Voriconazole compared to retrospective control regarding the infectious complications and incidence of fungal infection.

Results: One hundred thirty-six (136) newly diagnosed pediatric AML patients were included in the study, 61 patients didn't receive antifungal prophylaxis (Non-prophylactic arm) while 75 patients received Voriconazole prophylaxis (prophylactic arm). The median age among both groups was 5.5 years old. Thirty-one (50%) of the 61 patients in (non-prophylactic arm) and five (6.6%) of the 75 patients enrolled in group B (prophylactic arm) developed an invasive fungal infection. The most commonly affected sites were pulmonary (34/36) while fungal sinus infection was reported in 2 patients. Most patients develop an invasive fungal infection during the induction treatment phase. Primary prophylaxis with Voriconazole had a highly statistically significant impact on the reduction of incidence of invasive fungal infection between 2 groups (p-value=0.001). Fungal attributable mortality was reported in 8 patients (13%) in the historical group (no antifungal prophylaxis) in comparison to 2 patients (2.6%) in group patients received Voriconazole antifungal prophylaxis. Three Overall and Event-free survival were comparable between both groups.

Conclusion: Prophylactic Voriconazole significantly decreased the incidence of fungal infections but it had no impact on diseases or overall survival outcome. Bacterial sepsis and disease-related mortality was the main cause of deaths among our group patients.