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Mold-Active Antifungal Prophylaxis in Pediatric Patients with Cancer or Undergoing Hematopoietic Cell Transplantation
Thomas Lehrnbecher1, Konrad Bochennek1, Andreas H Groll2
1Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Johann Wolfgang Goethe University, 60589 Frankfurt am Main, Germany.
Abstract:
Invasive fungal diseases (IFDs), in particular invasive mold infections, still pose considerable problems in the care of children and adolescents treated for cancer or undergoing hematopoietic cell transplantation. As these infections are difficult to diagnose, and the outcomes for IFDs are still unsatisfactory, antifungal prophylaxis has become an important strategy in the clinical setting. Antifungal prophylaxis is indicated in patients at high risk for IFD, which is commonly defined as a natural incidence of at least 10%. As there is a growing interest in pediatric-specific clinical trials and pediatric-specific guidelines, this review focuses on the available data of mold-active antifungal prophylaxis in children and adolescents. The data demonstrate that a major effort is needed to characterize the pediatric patient population in which the net effect of prophylactic antifungals will be beneficial as well as to find the optimal prophylactic antifungal compound and dosage.
Insights
Antifungal prophylaxis is crucial for children and adolescents undergoing cancer treatment or transplantation to prevent invasive fungal diseases. Further research is needed to optimize antifungal compounds and dosages for this vulnerable pediatric population.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Invasive fungal diseases (IFDs), particularly invasive mold infections, present significant challenges in pediatric cancer care and hematopoietic cell transplantation.
- Current diagnostic methods for IFDs are limited, and treatment outcomes remain suboptimal, underscoring the need for effective preventive strategies.
- Antifungal prophylaxis is a key clinical strategy for high-risk patients, defined by an IFD incidence of at least 10%.
Purpose of the Study:
- To review available data on mold-active antifungal prophylaxis specifically in pediatric and adolescent populations.
- To highlight the need for pediatric-specific clinical trials and guidelines in managing IFDs.
- To identify optimal antifungal agents and dosages for prophylactic use in immunocompromised children.
Main Methods:
- Systematic review of existing literature on mold-active antifungal prophylaxis in pediatric patients.
- Analysis of data from clinical trials and observational studies.
- Evaluation of current guidelines and recommendations for antifungal prophylaxis in immunocompromised children.
Main Results:
- The review focuses on mold-active antifungal prophylaxis in children and adolescents.
- Data indicate a significant need for research to define the pediatric patient subgroups that benefit most from prophylactic antifungals.
- Identifying the optimal antifungal compound and dosage for pediatric prophylaxis is an ongoing challenge.
Conclusions:
- Antifungal prophylaxis is an essential component of care for high-risk pediatric patients to prevent invasive mold infections.
- Significant research efforts are required to personalize antifungal prophylaxis strategies for children and adolescents.
- Further studies are necessary to establish evidence-based, pediatric-specific guidelines for antifungal prophylaxis.
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