Ina 24-month-old girl with acute lymphoblastic leukemia and invasive aspergillosis, only combination therapy with liposomal amphotericin B and caspofungin achieved a good response. Combination therapy could be a useful treatment option in children with invasive fungal disease, but before it can be routinely recommended, carefully controlled in vivo studies and well-designed randomized clinical trials are needed.
Invasive aspergillosis continues to pose a significant threat to immunocompromised patients and has shown an increasing incidence over the last decades. 1, 2 Despite advances in supportive care, the fatality rate for patients with leukemia and invasive aspergillosis is higher than 50%. 1 Amphotericin B has been the cornerstone of systemic chemotherapy for invasive fungal infection during the last four decades, but new antimycotic agents, such as caspofungin, which is a member of the echinocandins, offer new therapeutic alternatives. However, despite extensive in vitro and animal studies of this drug, few clinical data have been published to date, in particular in pediatric patients. We report here on the unusual case of a 24-month-old girl who developed invasive aspergillosis early in induction therapy of acute lymphoblastic leukemia (ALL). Whereas the clinical condition of the girl was stabilized with amphotericin B, the pulmonary infiltrates showed a good response only to combination therapy with liposomal amphotericin B and caspofungin.
From the Departments of Pediatric Hematology and Oncology, Children′s Hospital III (ZE, JS, TK, TL) and Pediatric Radiology (HS), University of Frankfurt, Frankfurt; Children’s Hospital, Städtische Kliniken, Karlsruhe (WD); and Robert Koch-Institute (KT) and Hospital Sankt Gertrauden (GJ), Berlin, Germany.
Accepted for publication March 24, 2003.
Address for reprints: Thomas Lehrnbecher, M.D., Department of Pediatric Hematology and Oncology, Children′s Hospital III, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590 Frankfurt. Fax 49-69-6301-6700; E-mail firstname.lastname@example.org.