Presented in part at the American Society of Blood and Marrow Transplantation (ASBMT), February 2003, Keystone, CO, the American Society of Pediatric Hematology/Oncology/Pediatric Academic Societies, May 2003, Seattle, WA, and the International Society of Paediatric Oncology, September 2005, Vancouver, Canada.
Version of Record online: 18 MAY 2007
Copyright © 2007 Wiley-Liss, Inc.
Pediatric Blood & Cancer
Volume 50, Issue 2, pages 325–330, February 2008
How to Cite
Roman, E., Osunkwo, I., Militano, O., Cooney, E., van de Ven, C. and Cairo, M. S. (2008), Liposomal amphotericin B prophylaxis of invasive mold infections in children post allogeneic stem cell transplantation. Pediatr. Blood Cancer, 50: 325–330. doi: 10.1002/pbc.21239
Elizabeth Roman and Ifeyinwa Osunkwo contributed equally to this work.
- Issue online: 4 DEC 2007
- Version of Record online: 18 MAY 2007
- Manuscript Accepted: 15 MAR 2007
- Manuscript Received: 29 SEP 2006
- Pediatric Cancer Research Foundation
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. Grant Number: AR49330
- National Heart, Lung, and Blood Institute. Grant Number: T32 HL07968
- Child Health Research Career Development Award. Grant Number: 5K12HD43389-02
- Swim Across America Foundation, Marisa Fund, Sonia Scaramella Fund, Brittany Barron Foundation
- liposomal amphotericin B;
- mold prophylaxis;
Invasive mold infections (IMI) are a leading cause of infectious mortality in allogeneic stem cell transplant (AlloSCT) recipients. Fluconazole, the current standard for fungal prophylaxis, is ineffective against molds. We initiated a pilot study to determine the safety and activity of prophylactic liposomal amphotericin B (AMB) in preventing IMI in pediatric and adolescent AlloSCT recipients during the first 100 days.
Fifty-one patients (57 AlloSCT) were given AMB (3 mg/kg/day) intravenously, day 0–100. Median age 6 years, 32 males, 19 females. Donors: 33 unrelated and 2 related cord blood, 13 related and 1 unrelated peripheral blood stem cell and 8 related bone marrow (BM); 30 received myeloablative and 27 reduced intensity conditioning. Graft-versus-host disease (GVHD) prophylaxis comprised tacrolimus and mycophenolate mofetil.
Median follow-up is 557 days. AMB was generally well tolerated. The probability of developing ≥grade II acute GVHD and extensive chronic GVHD was 45% and 7%, respectively. Estimated 1-year OS is 62.4% for all patients with 78.8% and 26.7% for average-risk and poor-risk, respectively. The incidence of IMI was 0%.
These results suggest prophylactic AMB is tolerable and may prevent IMI, especially Aspergillus, during the first 100 days post AlloSCT in pediatric and adolescent patients. A randomized study is needed to determine the efficacy of this approach. Pediatr Blood Cancer 2008;50:325–330. © 2007 Wiley-Liss, Inc.