ABSTRACT
The antifungal agents most frequently used in prophylaxis and treatment are amphotericin B (and its new lipid forms) and azoles such as fluconazole, itraconazole, and more recently voriconazole. This review assesses the role of itraconazole in paediatric haematology/oncology practice. Its broader spectrum of activity and availability in oral and intravenous forms allow a flexible approach in the management of fungal infections.
Subject(s)
Antifungal Agents/therapeutic use , Itraconazole/therapeutic use , Mycoses/drug therapy , Absorption , Amphotericin B/adverse effects , Antifungal Agents/adverse effects , Antifungal Agents/pharmacokinetics , Aspergillosis/drug therapy , Candidiasis/drug therapy , Child, Preschool , Cost-Benefit Analysis , Humans , Itraconazole/adverse effects , Itraconazole/pharmacokinetics , Mycoses/prevention & controlABSTRACT
Three children, aged 7-10 years, with acute lymphoblastic leukaemia presented with back pain, along with a mild kyphosis. Collapse of the vertebral bodies at multiple levels was shown on imaging. Chemotherapy resulted in pain resolution and spontaneous remodelling of the vertebrae.
Subject(s)
Fractures, Spontaneous/etiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Spinal Fractures/etiology , Antineoplastic Agents/therapeutic use , Child , Female , Fractures, Spontaneous/diagnosis , Fractures, Spontaneous/drug therapy , Humans , Magnetic Resonance Imaging , Male , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Spinal Fractures/diagnosis , Spinal Fractures/drug therapy , Treatment OutcomeABSTRACT
Over a period of 14 years, 50 patients (12 children and 38 adults) of whom 46 had acute myeloid leukemia (AML) and 4 had myelodysplastic syndrome characterized by the t(8;21)(q22;q22) translocation were referred to the Royal Marsden Hospital. The clinicopathological features of these cases were analyzed to determine the influence of age, secondary karyotype abnormalities, and expression of the lymphoid marker CD19 on event free survival, and presence of extramedullary leukemia on overall survival. They were treated with a variety of chemotherapy protocols and some had bone marrow transplantation. There appeared to be no difference in survival between children (age <17 years) and adults (age >16 years). Out of the 50 cases, 16 (32%) had the (8;21) translocation alone, 17 (34%) had additional loss of a sex chromosome and the remaining 17 (34%) had other karyotype abnormalities of which deletion or translocation of the long arms of a #9 was most common (observed in 8 of the 17 patients). The karyotype groups had a significant impact on survival, the group with loss of a sex chromosome having a poorer outcome and the group with abnormalities of chromosome 9 having a better outcome. CD19 positivity was seen in 21 of the 33 cases (63%) in whom it was measured compared to 11% observed in controls with AML without a t(8;21). CD19 status did not exert any influence on event free survival. Extramedullary leukemia (EML) occurred in 5 of the 50 cases (10%). In one patient it was observed at diagnosis but in the others it presented concurrent with bone marrow relapse. The overall survival of patients with EML was worse than that of the other patients but did not achieve statistical significance and was probably adversely affected by other factors.
