Guideline for primary antifungal prophylaxis for pediatric patients with cancer or hematopoietic stem cell transplant recipients

Authors

  • Michelle Science MD, MSc,

    Corresponding author
    1. Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario
    2. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton Health Sciences, Hamilton, Ontario
    • Correspondence to: Michelle Science, MD, FRCPC, Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8.

      E-mail: michelle.science@sickkids.ca

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  • Paula D. Robinson MD, MSc,

    1. C17 Council, 3-590B Edmonton Clinic Health Academy (ECHA), Department of Pediatrics, University of Alberta, Edmonton, AB
    2. Pediatric Oncology Group of Ontario, Toronto, Ontario
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  • Tamara MacDonald PharmD,

    1. Department of Pharmacy, IWK Health Centrem, Dalhousie University, Halifax, Nova Scotia
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  • Shahrad Rod Rassekh MD, MHSc,

    1. Division of Pediatric Hematology/Oncology/BMT, BC Children's Hospital, Vancouver, British Columbia
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  • L. Lee Dupuis MSc, Phm, FCSHP,

    1. Department of Pharmacy, The Hospital for Sick Children, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
    2. Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario
    3. Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario
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  • Lillian Sung MD, PhD

    1. Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario
    2. Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario
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  • L. Lee Dupuis and Lillian Sung equally contributed to this work.
  • Conflict of interest: Nothing to declare.
  • Contributors: All authors conceived and designed the study. MS reviewed the titles and abstracts, selected studies for full text review, reviewed the papers for inclusion and extracted the data. All authors interpreted the data, reviewed the draft and approved the final version for publication.

Abstract

This guideline provides clinicians with evidence-based recommendations on the use of antifungal prophylaxis in children with cancer and undergoing hematopoietic stem cell transplantation (HSCT). Recommendations are divided into: (1) allogeneic HSCT (2) autologous HSCT (3) acute myeloid leukemia or myelodysplastic syndrome and (4) patients with malignancy and neutropenia for >7 days. A systematic review was conducted and evidence summaries compiled. The quality of evidence and strength of each recommendation was determined using GRADE. Implementation of these recommendations will require adaptation to local context. The contribution of this guideline in the prevention of invasive fungal infections requires prospective evaluation. Pediatr Blood Cancer 2014;61:393–400. © 2013 Wiley Periodicals, Inc.

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