A prospective, randomized study of empirical antifungal therapy for the treatment of chemotherapy-induced febrile neutropenia in children

Désirée Caselli, Simone Cesaro, Ottavio Ziino, Pietro Ragusa, Alfredo Pontillo, Anna Pegoraro, Nicola Santoro, Giulio Zanazzo, Vincenzo Poggi, Mareva Giacchino, Susanna Livadiotti, Fraia Melchionda, Marcello Chiodi, Maurizio Aricò

Research output: Contribution to journalArticlepeer-review

Abstract

Given that the rationale for empirical antifungal therapy in neutropenic children is limited and based on adult patient data, we performed a prospective, randomized, controlled trial that evaluated 110 neutropenic children with persistent fever. Those at high risk for invasive fungal infections (IFI) received caspofungin (Arm C) or liposomal amphotericinB (Arm B); those with a lower risk were randomized to receive Arm B, C, or no antifungal treatment (Arm A). Complete response to empirical antifungal therapy was achieved in 90/104 patients (86·5%): 48/56 at high risk (85·7%) [88·0% in Arm B; 83·9% in Arm C (P = 0·72)], and 42/48 at low risk (87·5%) [87·5% in control Arm A, 80·0% Arm B, 94·1% Arm C; (P = 0·41)]. None of the variables tested by multiple logistic regression analysis showed a significant effect on the probability to achieve complete response. IFI was diagnosed in nine patients (8·2%, 95% confidence interval, 3·8-15·0). This randomized controlled study showed that empirical antifungal therapy was of no advantage in terms of survival without fever and IFI in patients aged

Original languageEnglish
Pages (from-to)249-255
Number of pages7
JournalBritish Journal of Haematology
Volume158
Issue number2
DOIs
Publication statusPublished - Jul 2012

Keywords

  • Cancer
  • Children
  • Empirical antifungal therapy

ASJC Scopus subject areas

  • Hematology

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