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Voriconazole Prophylaxis in Children With Cancer: Changing Outcomes and Epidemiology of Fungal Infections

Maron, Gabriela M. MD*; Hayden, Randall T. MD; Rodriguez, Alicia MS; Rubnitz, Jeffrey E. MD; Flynn, Patricia M. MD*§¶; Shenep, Jerry L. MD; Knapp, Katherine M. MD

Pediatric Infectious Disease Journal: December 2013 - Volume 32 - Issue 12 - p e451–e455
doi: 10.1097/INF.0b013e3182a74233
Original Studies

Background: Invasive mould infections are a significant cause of morbidity and mortality in pediatric cancer patients, particularly in those undergoing aggressive myeloablative chemotherapy. Voriconazole has been described as an appropriate and effective prophylactic agent in adults with cancer.

Methods: We compared the etiology, predisposing factors and outcomes of invasive mould infection in patients treated for acute myeloid leukemia before and after implementation of voriconazole prophylaxis in a pediatric cancer center.

Results: We observed no difference in the number of invasive mould infection between groups. However, isolated organisms were markedly different, with a shift from aspergillosis to phaeohyphomycosis after the implementation of voriconazole prophylaxis. Survival at 90 days was improved in patients receiving voriconazole prophylaxis (P = 0.05). We did not identify a significant increase in the incidence of zygomycosis associated with routine use of voriconazole prophylaxis.

Conclusions: Voriconazole prophylaxis was associated with improved survival in pediatric patients with acute myeloid leukemia, although other factors may be involved. Voriconazole prophylaxis was associated with a marked change in the pattern of mould infections, with a significant reduction in aspergillosis

From the Departments of *Infectious Diseases, Pathology, and Oncology, St. Jude Children’s Research Hospital; and Departments of §Pediatrics and Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN.

Accepted for publication July 29, 2013.

J.L.S. submitted posthumously.

This work was supported in part by the American Lebanese Syrian Associated Charities. The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Gabriela M. Maron, MD, Department of Infectious Diseases, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail Stop 600, Memphis, TN 38105-3678. E-mail: gabriela.maron@stjude.org.

© 2013 by Lippincott Williams & Wilkins, Inc.