RESULTS
Fifty-six PP events were identified in 47 patients. The mean age of the
patients was 7.5 years (IQR 4-10), and 24 (51.6%) were female. The
underlying medical conditions were aplastic anemia (n=19, 33.93%),
acute lymphoid leukemia (n=18, 32.14%), acute myeloid leukemia (n = 14,
25.0%), Fanconi anemia (n=2, 3.57%), thalassemia (n=1, 1.79%),
primary immunodeficiency (n=1, 1.79%), and myelodysplastic syndrome
(n=1, 1.79%). In addition, 34.1% underwent HSCT (haploid: 21.3%;
allogenic: 12.8%) and of these, 6 (10.71%) developed GVHD.
The median dose of posaconazole used was 13.6 mg/kg/day (IQR 12 - 16.8).
The median duration of PP was 24 days (IQR 16- 82), with. 33.9%
concomitantly using proton pump inhibitors and 7.14% had mucositis. The
median absolute neutrophil count before the beginning PP was 600
cells/mL (IQR: 150- 1980). The clinical and laboratory findings during
the use of PP are shown in Table 1.
There were significant difference between the median ALT values before
(33.5, IQR: 13-61.5), during (70, IQR: 43-133) and after discontinuation
(39, IQR: 25.5-79.5) of PP (p < 0.001), and when comparing the
values during prophylaxis with the values before (p <
0.001) and after PP suspension (p<0.001). No significant
differences were found between the median ALT levels before and after
stopping PP (p = 0.205). Significant differences were observed between
the median AST levels before (30, IQ: 21-43), during (59, IQ: 35-103.5),
and after the discontinuation (31.5, IQ: 22-46) of PP (p <
0.001). Likewise, there were significant differences between the values
during prophylaxis compared with the values before (p <
0.001) and after the suspension of PP (p < 0.001). There were
no significant differences between the median ALT levels before and
after stopping PP (p = 0.552) (Figure 1).
We identified five breakthrough fungal infections, four of which (4/5)
corresponded to invasive aspergillosis (2 probable and 2 possible), and
one (1/5) invasive candidiasis. Of the total patients, 15 (31.91%) had
a prior history of IFI (11 invasive aspergillosis and 4 invasive
candidiasis). Table 2 shows the characteristics of the cases presenting
breakthrough fungal infections.