Usefulness of serum galactomannan in initiating and modifying antifungal therapy in children with cancer and persistent high-risk febrile neutropenia.
Antifungal Agents
/ therapeutic use
Aspergillosis
/ drug therapy
Case-Control Studies
Chemotherapy-Induced Febrile Neutropenia
/ complications
Child
Female
Galactose
/ analogs & derivatives
Hematologic Neoplasms
/ complications
Humans
Invasive Fungal Infections
/ drug therapy
Invasive Pulmonary Aspergillosis
/ drug therapy
Male
Mannans
/ blood
Neoplasms
/ complications
antifungal agents
aspergillosis
chemotherapy-induced febrile neutropenia
febrile neutropenia in children
galactomannan
infectious diseases
invasive fungal infections
paediatric oncology
paediatrics
Journal
Mycoses
ISSN: 1439-0507
Titre abrégé: Mycoses
Pays: Germany
ID NLM: 8805008
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
received:
31
01
2020
revised:
20
04
2020
accepted:
21
04
2020
pubmed:
30
4
2020
medline:
10
4
2021
entrez:
30
4
2020
Statut:
ppublish
Résumé
Invasive fungal disease is a major cause of morbidity and mortality in children with cancer and high-risk febrile neutropenia (HRFN). Repeated serum galactomannan (sGM) measurements have been described as an effective tool to guide therapy in adults under suspicion of invasive aspergillosis. However, the utility of this approach has not been reported in paediatric population. To evaluate the usefulness of sGM measurements in initiating and modifying antifungal therapy (AFT) in children with cancer and persistent HRFN. Nested case-control study in children with cancer and persistent HRFN episodes, between July 2013 and January 2019. Patients were classified as cases and controls depending on if they received AFT or not, respectively. Through odds ratio analysis, we assessed the role of sGM positivity in the AFT initiation decision. Then, we analysed the group of patients that initiated AFT, and compared those who had AFT modifications and those who did not, analysing different sGM kinetics thresholds. A total of 191 episodes from children with persistent HRFN were enrolled, of which 107 received AFT and 84 did not. The median age was 7 years (IQR 4-12), 52% were male and 89% had a haematologic malignancy as underlying disease. Positive sGM was not associated with AFT initiation (OR 0.99, 95% CI 0.43-2.33, P = .99). A difference threshold in sGM Δ ≥ 0.3 sGM was significantly associated with AFT modification (OR 5.07, 95% CI 1.02- 25.70, P = .04). Our results suggest the utility of serial sGM sampling during AFT in children with persistent HRFN.
Sections du résumé
BACKGROUND
BACKGROUND
Invasive fungal disease is a major cause of morbidity and mortality in children with cancer and high-risk febrile neutropenia (HRFN). Repeated serum galactomannan (sGM) measurements have been described as an effective tool to guide therapy in adults under suspicion of invasive aspergillosis. However, the utility of this approach has not been reported in paediatric population.
OBJECTIVES
OBJECTIVE
To evaluate the usefulness of sGM measurements in initiating and modifying antifungal therapy (AFT) in children with cancer and persistent HRFN.
PATIENTS/METHODS
METHODS
Nested case-control study in children with cancer and persistent HRFN episodes, between July 2013 and January 2019. Patients were classified as cases and controls depending on if they received AFT or not, respectively. Through odds ratio analysis, we assessed the role of sGM positivity in the AFT initiation decision. Then, we analysed the group of patients that initiated AFT, and compared those who had AFT modifications and those who did not, analysing different sGM kinetics thresholds.
RESULTS
RESULTS
A total of 191 episodes from children with persistent HRFN were enrolled, of which 107 received AFT and 84 did not. The median age was 7 years (IQR 4-12), 52% were male and 89% had a haematologic malignancy as underlying disease. Positive sGM was not associated with AFT initiation (OR 0.99, 95% CI 0.43-2.33, P = .99). A difference threshold in sGM Δ ≥ 0.3 sGM was significantly associated with AFT modification (OR 5.07, 95% CI 1.02- 25.70, P = .04).
CONCLUSIONS
CONCLUSIONS
Our results suggest the utility of serial sGM sampling during AFT in children with persistent HRFN.
Substances chimiques
Antifungal Agents
0
Mannans
0
galactomannan
11078-30-1
Galactose
X2RN3Q8DNE
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
802-811Subventions
Organisme : Fondo Nacional de Desarrollo Científico y Tecnológico
ID : 1120800
Organisme : Fondo Nacional de Desarrollo Científico y Tecnológico
ID : 1161662
Informations de copyright
© 2020 Blackwell Verlag GmbH.
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