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

Youssef Madney; Omar Arafah; Hader Elmahalawy; Lobna Shalby

doi:doi:10.11648/j.crj.20190702.15

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

Youssef Madney, Omar Arafah, Hader Elmahalawy, Lobna Shalby

Published in Cancer Research Journal (Volume 7, Issue 2)

Received: 2 May 2019 Accepted: 11 June 2019 Published: 24 June 2019

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Abstract

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. 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 showed that 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.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. In 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.

Published in	Cancer Research Journal (Volume 7, Issue 2)
DOI	10.11648/j.crj.20190702.15
Page(s)	58-65
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Acute Myeloid Leukemia, Invasive Fungal Infection, Voriconazole

References

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APA Style

Youssef Madney, Omar Arafah, Hader Elmahalawy, Lobna Shalby. (2019). Efficacy of Voriconazole Prophylaxis in Pediatric Patients with Acute Myeloid Leukemia, Single Center Experience, Egypt. Cancer Research Journal, 7(2), 58-65. https://doi.org/10.11648/j.crj.20190702.15

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ACS Style

Youssef Madney; Omar Arafah; Hader Elmahalawy; Lobna Shalby. Efficacy of Voriconazole Prophylaxis in Pediatric Patients with Acute Myeloid Leukemia, Single Center Experience, Egypt. Cancer Res. J. 2019, 7(2), 58-65. doi: 10.11648/j.crj.20190702.15

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AMA Style

Youssef Madney, Omar Arafah, Hader Elmahalawy, Lobna Shalby. Efficacy of Voriconazole Prophylaxis in Pediatric Patients with Acute Myeloid Leukemia, Single Center Experience, Egypt. Cancer Res J. 2019;7(2):58-65. doi: 10.11648/j.crj.20190702.15

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@article{10.11648/j.crj.20190702.15,
  author = {Youssef Madney and Omar Arafah and Hader Elmahalawy and Lobna Shalby},
  title = {Efficacy of Voriconazole Prophylaxis in Pediatric Patients with Acute Myeloid Leukemia, Single Center Experience, Egypt},
  journal = {Cancer Research Journal},
  volume = {7},
  number = {2},
  pages = {58-65},
  doi = {10.11648/j.crj.20190702.15},
  url = {https://doi.org/10.11648/j.crj.20190702.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.crj.20190702.15},
  abstract = {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. 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 showed that 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.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. In 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.},
 year = {2019}
}

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TY - JOUR
T1 - Efficacy of Voriconazole Prophylaxis in Pediatric Patients with Acute Myeloid Leukemia, Single Center Experience, Egypt
AU - Youssef Madney
AU - Omar Arafah
AU - Hader Elmahalawy
AU - Lobna Shalby
Y1 - 2019/06/24
PY - 2019
N1 - https://doi.org/10.11648/j.crj.20190702.15
DO - 10.11648/j.crj.20190702.15
T2 - Cancer Research Journal
JF - Cancer Research Journal
JO - Cancer Research Journal
SP - 58
EP - 65
PB - Science Publishing Group
SN - 2330-8214
UR - https://doi.org/10.11648/j.crj.20190702.15
AB - 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. 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 showed that 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.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. In 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.
VL - 7
IS - 2
ER -

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Author Information

Youssef Madney

Pediatric Oncology Department, National Cancer Institute, Cairo University, Children Cancer Hospital, Cairo, Egypt
Omar Arafah

Pediatric Oncology Department, National Cancer Institute, Cairo University, Children Cancer Hospital, Cairo, Egypt
Hader Elmahalawy

Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
Lobna Shalby

Pediatric Oncology Department, National Cancer Institute, Cairo University, Children Cancer Hospital, Cairo, Egypt

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APA Style

Youssef Madney, Omar Arafah, Hader Elmahalawy, Lobna Shalby. (2019). Efficacy of Voriconazole Prophylaxis in Pediatric Patients with Acute Myeloid Leukemia, Single Center Experience, Egypt. Cancer Research Journal, 7(2), 58-65. https://doi.org/10.11648/j.crj.20190702.15

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ACS Style

Youssef Madney; Omar Arafah; Hader Elmahalawy; Lobna Shalby. Efficacy of Voriconazole Prophylaxis in Pediatric Patients with Acute Myeloid Leukemia, Single Center Experience, Egypt. Cancer Res. J. 2019, 7(2), 58-65. doi: 10.11648/j.crj.20190702.15

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AMA Style

Youssef Madney, Omar Arafah, Hader Elmahalawy, Lobna Shalby. Efficacy of Voriconazole Prophylaxis in Pediatric Patients with Acute Myeloid Leukemia, Single Center Experience, Egypt. Cancer Res J. 2019;7(2):58-65. doi: 10.11648/j.crj.20190702.15

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@article{10.11648/j.crj.20190702.15,
  author = {Youssef Madney and Omar Arafah and Hader Elmahalawy and Lobna Shalby},
  title = {Efficacy of Voriconazole Prophylaxis in Pediatric Patients with Acute Myeloid Leukemia, Single Center Experience, Egypt},
  journal = {Cancer Research Journal},
  volume = {7},
  number = {2},
  pages = {58-65},
  doi = {10.11648/j.crj.20190702.15},
  url = {https://doi.org/10.11648/j.crj.20190702.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.crj.20190702.15},
  abstract = {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. 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 showed that 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.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. In 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.},
 year = {2019}
}

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