Blood Res 2017; 52(3): 167-173  https://doi.org/10.5045/br.2017.52.3.167
Voriconazole plus caspofungin for treatment of invasive fungal infection in children with acute leukemia
Kyu Ho Lee1, Young Tae Lim1, Jeong Ok Hah2, Yu Kyung Kim3, Chae Hoon Lee4, Jae Min Lee1
Department of Pediatrics, 1College of Medicine, Yeungnam University, 2Daegu Fatima Hospital, 3Department of Clinical Pathology, Kyungpook National University School of Medicine, 4Department of Laboratory Medicine, College of Medicine, Yeungnam University, Daegu, Korea
Correspondence to: Jae Min Lee, M.D., Ph.D.Department of Pediatrics, Yeungnam University Hospital, 170, Hyeonchung-ro, Nam-gu, Daegu 42415, KoreaE-mail: mopic@yu.ac.kr
Received: January 25, 2017; Revised: May 25, 2017; Accepted: June 8, 2017; Published online: September 30, 2017.
© The Korean Journal of Hematology. All rights reserved.

Abstract
Background 
Invasive fungal infections (IFIs) are a life-threatening problem in immunocompromised patients. Despite timely diagnosis and appropriate antifungal therapy, clinical outcomes of IFIs remain unsatisfactory, necessitating treatment with a combination of antifungal agents. Therefore, childhood leukemic patients treated with voriconazole plus caspofungin were evaluated for the safety and efficacy of the combination antifungal therapy to treat IFIs.
Methods 
In this retrospective study, medical records were retrieved for patients admitted to the Pediatric Department of Yeungnam University Hospital, Daegu, South Korea, between April 2009 and May 2013. Medical records of 22 patients were analyzed.
Results
Of the 22 patients studied, nine (41%) had been diagnosed with probable IFI, and 13 (59%) with possible IFI. All patients, except one, were already receiving antifungal monotherapy for the treatment of neutropenic fever. After a diagnosis of IFI was confirmed, antifungal monotherapy was replaced with combination therapy. The study’s overall response rate was 90.9%, with complete responses in 86.3% of the patients. Two patients experienced a side effect of a small increase in liver enzyme levels.
Conclusion
Voriconazole plus caspofungin combination therapy is an effective and safe treatment for serious IFI in pediatric patients with acute leukemia.
Keywords: Antifungal agent, Aspergillosis, Caspofungin, Echinocandins, Invasive fungal infections, Voriconazole


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