JAC Advance Access originally published online on January 23, 2006
Journal of Antimicrobial Chemotherapy 2006 57(3):527-535; doi:10.1093/jac/dkl009
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Treatment with caspofungin in immunocompromised paediatric patients: a multicentre survey
1 Department of Paediatric Haematology/Oncology, Children's University Hospital, Muenster, Germany; 2 Children's University Hospital, Munich, Germany; 3 University Hospital Wuerzburg, Wuerzburg, Germany; 4 Children's Hospital, Medical School Hannover, Hannover, Germany; 5 Children's University Hospital, Hamburg-Eppendorf, Germany; 6 University Children's Hospital, Duesseldorf, Germany; 7 Department of Paediatric Haemotology, Children's University Hospital, Frankfurt, Germany; 8 St Anna Children's Hospital, Vienna, Austria
Received 29 August 2005; returned 1 November 2005; revised 14 December 2005; accepted 2 January 2006
* Correspondence address. Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology/Oncology, Children's University Hospital, Albert-Schweitzer-Strasse 33, 48129 Muenster, Germany. Tel: +49-251-835-2801; Fax: +49-251-835-2804; E-mail: grollan{at}ukmuenster.de
Objectives: Although a paediatric dosage has not been established, caspofungin is occasionally used in paediatric patients. We conducted a multicentre retrospective survey to obtain data on immunocompromised paediatric patients considered to require caspofungin therapy.
Methods: The survey identified 64 patients (median age: 11.5 years; 25 females, 39 males) with haematological malignancies (48), marrow failure (9), solid tumours (3), haematological disorders (2) and congenital immunodeficiency (2) who received caspofungin for proven (17), probable (14) and possible (17) invasive fungal infections or empirically (16). Caspofungin was administered until intolerance or maximum efficacy at dosages individually determined by the responsible physician for refractory infection (38), intolerance of other agents (10) or as best therapeutic option (16).
Results: The 64 patients received caspofungin for a median of 37 days (range 3–218) as single agent (20) or in combination (44). The median daily maintenance dosage was 1.07 mg/kg (95% CI 1.09–1.35; range 0.40–2.92) or 34.3 mg/m2 (95% CI 32.3–37.3; range 16.3–57.5). In none of the patients was therapy discontinued due to adverse events (AEs). Clinical AEs were mild to moderate and observed in 34 patients (53.1%). While mean glutamate pyruvate transaminase and glutamate oxalate transaminase values were slightly (P < 0.005) higher at the end of treatment (EOT), serum bilirubin, alkaline phosphatase and creatinine values were not different from baseline. Complete responses, partial responses or stabilization were observed in 5/7/3 of 17 patients with proven, in 3/4/3 of 14 patients with probable and in 7/6/1 of 15 evaluable patients with possible invasive infections. Thirteen of 16 patients on empirical therapy completed without breakthrough infection. Overall survival was 75% at the EOT and 70% at 3 months post-EOT, respectively.
Conclusions: Caspofungin displayed favourable safety and tolerance and may have useful antifungal efficacy in severely immunocompromised paediatric patients.
Keywords: echinocandins , mycoses , children , cancer , immunodeficiency
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