Results of liposomal amphotericin B treatment in pediatric invasive fungal infections: a single-center experience

Introduction
Invasive fungal infections (IFIs) are a common problem, and a major cause of morbidity and mortality in immunocompromised children. Most of them have at least one IFI during long and intensive treatment administered in oncology and hematology departments. Due to limited diagnostic options, final diagnosis of IFIs is often difficult and time-consuming, therefore empirical or prophylactic antifungal treatment is frequently initiated to avoid delays in therapy. The limited overall outcome led to the strategy of initiat­ing either empirical or pre-emptive antifungal therapy before final diagnosis. One of the most effective antifungal drugs is liposomal amphotericin B (LAmB). The aim of the study was to retrospectively analyze patients treated using LAmB at the Department of Pediatric Oncology and Hematology UCH between 2015 and 2022.

Material and methods
Study group included 59 patients, aged 2–18 years (53% boys, 47% girls). Half of children were diagnosed with acute leukemia (acute lymphoblastic leukemia: 33%, acute myeloid leukemia: 17%), while the other half suffered from different cancers and immune disorders, such as Burkitt’s lymphoma, T-cell non-Hodgkin lymphoma, Ewing’s sarcoma, osteosarcoma, synovial sarcoma, neuroblastoma, central nervous system tumors, aplastic anemia, hemophagocytic histiocytosis, severe combined immunodeficiency, and gona­doblastoma. Data concerning patients status, therapy, and follow-up, including primary disease, chemo/radiotherapy, immune status, neutropenia duration, indications for antifungal therapy, response to therapy, supportive treatment, and complications, were analyzed.

Results
Eighty percent of patients received LAmB as empirical treatment. In 46% of patients, LAmB was applied as monotherapy, while in combination, micafungin, fluconazole, or voriconazole were used. Almost all patients presented an altered immune status due to pancytopenia and hypogammaglobulinemia. The median time of neutropenia before fungal infection was 19 days. Complications observed during LAmB therapy included liver and/or kidney dysfunctions and important electrolytes alteration. However, 76% of patients responded to the treatment.

Conclusions
The results indicated that adverse events were not linked to the cumulative dose of LAmB. There were no significant differences in cumulative doses between patients who experienced adverse events and those who did not. Kidney-related adverse events were weakly associated with fatal outcomes.