Pediatric blood & cancer · 2025
Preemptive Versus Empirical Antifungal Therapy for High-Risk, Febrile, Neutropenic Solid Tumor Patients in an LMIC Setting.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Al-Qadi Omnia, Shalaby Lobna, Anany Mervat El, Zaky Iman, Naguib Maggie, Kashef Amr, Hassanain Omneya, Zamzam Manal, Lehmann Leslie, Haddad Alaa El
Аннотация
BACKGROUND: Preemptive antifungal therapy in neutropenic fever offers a rational alternative to the empiric strategy, potentially reducing drug toxicity, resistance, and treatment-related costs. However, its implementation in the Middle East and North Africa (MENA) region remains insufficiently addressed.
METHODS: We prospectively observed episodes of neutropenia in pediatric patients with solid tumors and prolonged neutropenia. This non-inferiority cohort study evaluated two primary endpoints: the cumulative incidence of invasive fungal infection (IFI), IFI-attributable mortality. Outcomes from the prospective cohort managed with a preemptive strategy were compared with retrospective data from a historical cohort treated with the previously used empiric approach.
RESULTS: A total of 422 preemptive episodes were prospectively recorded, and data from 338 historical empiric episodes were retrospectively reviewed. The incidence of IFI was comparable between the two groups (4.5% in the preemptive group vs. 5.6% in the empiric group; p = 0.5). However, antifungal use was significantly lower in the preemptive group (5.0% vs. 58.0%; p < 0.001). Overall survival was higher in the preemptive group (98.9% vs. 94.6%). No IFI-attributable mortality was recorded in either group.
INTERPRETATION: The combined EIA/HRCT-based preemptive strategy is feasible and associated with reduced antifungal use without compromising patient outcomes in pediatric patients with solid tumors and prolonged neutropenia.
METHODS: We prospectively observed episodes of neutropenia in pediatric patients with solid tumors and prolonged neutropenia. This non-inferiority cohort study evaluated two primary endpoints: the cumulative incidence of invasive fungal infection (IFI), IFI-attributable mortality. Outcomes from the prospective cohort managed with a preemptive strategy were compared with retrospective data from a historical cohort treated with the previously used empiric approach.
RESULTS: A total of 422 preemptive episodes were prospectively recorded, and data from 338 historical empiric episodes were retrospectively reviewed. The incidence of IFI was comparable between the two groups (4.5% in the preemptive group vs. 5.6% in the empiric group; p = 0.5). However, antifungal use was significantly lower in the preemptive group (5.0% vs. 58.0%; p < 0.001). Overall survival was higher in the preemptive group (98.9% vs. 94.6%). No IFI-attributable mortality was recorded in either group.
INTERPRETATION: The combined EIA/HRCT-based preemptive strategy is feasible and associated with reduced antifungal use without compromising patient outcomes in pediatric patients with solid tumors and prolonged neutropenia.