isavuconazole and Precursor-Cell-Lymphoblastic-Leukemia-Lymphoma

Invasive mucormycosis in immunocompromised children is a life-threatening fungal infection. We report a case of a 7-year-old girl treated for acute lymphoblastic leukaemia complicated by disseminated mucormycosis during induction therapy. Microscopic examination of surgically removed lung tissue revealed wide, pauci-septate hyphae suggesting a Mucorales infection. This diagnosis was confirmed immunohistochemically and by PCR analysis followed by a final identification of Cunninghamella sp. The patient was treated successfully with surgical debridement and antifungal combination therapy with amphotericin B, caspofungin and isavuconazole. The use of isavuconazole in a child was not previously reported. Additionally, case reports concerning pulmonary mucormycoses in paediatric population published after 2010 were reviewed. Nineteen out of 26 identified patients suffered from haematological diseases. Reported mortality reached 38.5%. By the fact of rising morbidity, unsatisfactory results of treatment and remaining high mortality of mucormycoses in immunocompromised patients, new therapeutic options are warrant. Isavuconazole, with its broad-spectrum activity, good safety profile and favourable pharmacokinetics, is a promising drug. However, further studies are necessary to confirm positive impact of isavuconazole on mucormycosis treatment in children.

Topics: Amphotericin B; Antifungal Agents; Caspofungin; Child; Cunninghamella; Debridement; Drug Therapy, Combination; Drug-Related Side Effects and Adverse Reactions; Female; Hemochromatosis; Humans; Invasive Fungal Infections; Mucormycosis; Nitriles; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pyridines; Treatment Outcome; Triazoles

Invasive aspergillosis in hematologic pediatric patients is an opportunistic infection that is difficult to treat, with a high mortality rate when localized in the central nervous system. We are describing a 3-year-old girl who was affected by acute lymphoblastic leukemia who developed cerebral and pulmonary aspergillosis during induction chemotherapy. The patient failed first-line voriconazole treatment because of being a CYP2C19 ultrarapid metabolizer and received effective isavuconazole therapy with no notable side effects.

Topics: Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillus; Child, Preschool; Female; Humans; Neuroaspergillosis; Nitriles; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prognosis; Pulmonary Aspergillosis; Pyridines; Triazoles

Invasive mold infections (IMIs) are a leading cause of mortality among immunocompromised patients. Isavuconazole is a new drug that shows promise in the adult population for the treatment of IMIs. No data regarding the use of isavuconazole in pediatric patients have been published.. Patients with a diagnosis of IMI from our pediatric hemato-oncology division, treated with isavuconazole between 2010 and 2016, were identified using the hospital's computerized database. Data including demographics, clinical course, and outcome were collected. Pharmacokinetic samples were obtained from two younger patients to guide dosing.. In total, three patients (4.5, 5, and 19 years of age) with invasive mucormycosis who were treated with isavuconazole were identified. All patients were treated with isavuconazole as a second line therapy and experienced improvement following the initiation of this treatment.. Based on our limited clinical experience, isavuconazole may be a safe and effective treatment option for children and adolescents afflicted by IMI. Prospective clinical trials should be performed in order to evaluate the pharmakokinetics and safety of isavuconazole in the pediatric population.

Topics: Adolescent; Antifungal Agents; Antineoplastic Agents; Child, Preschool; Female; Hodgkin Disease; Humans; Immunocompromised Host; Male; Mucormycosis; Nitriles; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pyridines; Treatment Outcome; Triazoles