血造性幹細胞移植を受けた小児患者の静脈内ポサコナゾールの使用

Carolyn Kusoski¹, Parinda A Mehta², Justin Markham³

¹Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

|September 5, 2025

まとめ

静脈注射ポサコナゾールは,小児の造血幹細胞移植 (HSCT) 患者において,真菌感染症の予防と治療において,標的値を効果的に達成する. 肝臓機能障害が最も一般的な有害事象で,維持用投与に続く10 mg/ kgの負荷用量は安全で有効であることが示されました.

科学分野:

薬理学について
血液学
感染症

背景:

小児造血幹細胞移植 (HSCT) 患者は侵入性キノコ感染症のリスクが高い.
従来の経口ポサコナゾールは,胃腸疾患によるHSCT患者での吸収が不確実である.
静脈注射 (IV) のポサコナゾールは,この脆弱な集団における真菌感染症の管理に不可欠です.

研究の目的:

小児のHSCT患者の真菌感染予防と治療におけるIVポサコナゾールの安全性と有効性を評価する.
ポサコナゾールの目標値を達成するための最適な用量戦略を決定する.
このコホートにおけるIVポサコナゾール使用に関連した有害事象を特定する.

主な方法:

2015年1月から2023年8月までポサコナゾルをIV投与した小児HSCT患者の遡及的チャートレビュー.
投与方法の分析,薬剤目標値の達成,および臨床結果
副作用の評価,特に肝臓機能障害

主要な成果:

96. 3%の患者は,ポサコナゾールの目標濃度を1回の治療で達成した.
10 mg/ kgの重量ベースの中位量は,予防と治療の両方において有効でした.
肝機能不全は最も一般的な副作用 (中止の86%),しかし多くの患者は治療を再開することができました.

結論:

ポサコナゾルの入口投与は,12時間毎に10 mg/ kgの2回投与と,その後24時間毎に10 mg/ kgの2回投与で,小児のHSCT患者にとって有効です.
IVポサコナゾールは好ましい安全性プロファイルを示し,肝臓機能障害は管理できます.
この研究は,小児のHSCT患者におけるIVポサコナゾールの有効性の最大規模の評価である.

キーワード:

抗真菌剤造血幹細胞移植小児科ポサコナゾール

さらに関連する動画

03:40

Author Spotlight: Exploring the Lifespan Dynamics of Healthy Human Hematopoiesis

Published on: December 8, 2023

1.3K

08:04

Development of an IFN-γ ELISpot Assay to Assess Varicella-Zoster Virus-specific Cell-mediated Immunity Following Umbilical Cord Blood Transplantation

Published on: July 9, 2014

15.9K

関連する概念動画

01:22

Bone Marrow Sampling and Transplants

491

Bone marrow transplant is a potential cure for several diseases, including cancer and specific genetic disorders. Notably, this procedure is applicable for patients suffering from aplastic anemia, certain types of leukemia, severe combined immunodeficiency disease (SCID), Hodgkin's disease, non-Hodgkin's lymphoma, multiple myeloma, thalassemia, sickle-cell disease, and certain cancers.
The transplant begins with high doses of chemotherapy and radiation treatment, which aim to destroy...

491

01:16

Kidney Transplant III: Nursing Management

Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...

01:15

Drug Dosage Regimen: Overview

3.8K

A drug dosage regimen describes the specific instructions and schedule for administering a drug to a patient. It considers factors such as drug dosage, frequency, route of administration, and duration of treatment. Designing an appropriate dosage regimen for a patient aims to achieve a target drug concentration at the site of action.
Typically, the starting dose and dosing interval are guided by the manufacturer's recommendations based on clinical trials conducted during and after drug...

3.8K

01:11

Renal Failure: Dose Adjustments

151

In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...

151

01:19

Multipotency of Hematopoietic Stem Cells

3.3K

The hematopoietic stem cells or HSCs are multipotent, meaning they can differentiate and give rise to all blood and immune cells. HSCs are maintained in the quiescent stage until an external stimulus initiates their differentiation. The multipotent HSCs exist as two heterogeneous populations, long-term repopulating cells (LTRC) and short-term repopulating cells (STRC). The two HSC populations have different surface markers or receptors and are classified based on quiescence and long-term...

3.3K

01:28

Kidney Transplant I: Introduction

A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...

関連する実験動画