Antifungal combination therapy for invasive fungal infections in a paediatric oncology and haematology department: A retrospective analysis of practice.

BACKGROUND: Invasive fungal infections (IFI) are an important cause of morbidity and mortality in children with leukaemia. International guidelines recommend a monotherapy for most IFI. The use of antifungal combination therapy (ACT) has been reported, but clinical data supporting these combinations are scarce, particularly in paediatrics. OBJECTIVE: To describe, among patients treated in our department, the situations in which an ACT was used. RESULTS: Between January 2017 and December 2020, 239 patients (406 hospital stays) benefited from systemic antifungals. Among them, ACT was prescribed for 14 (5.9%) patients (13 leukaemia, 1 aplastic anaemia) corresponding to 16 (3.9%) hospital stays. IFI cases treated with ACT were mainly proven (n=9) or probable (n=4). Seven cases required admission to the intensive care unit. The most commonly used antifungal agents were liposomal amphotericin B (n=13), caspofungin (n=12) and voriconazole (n=9). In 13 cases, monotherapy was prescribed as first-line therapy and changed to an ACT for an uncontrolled infection. But in 3 cases, the ACT was started immediately. The response at 12 weeks after diagnosis of proven/probable IFI was successful in 12 cases (92.3%). The only IFI-related death was attributed to disseminated mucormycosis. ACT were generally well tolerated. In 4 cases, adverse events led to the discontinuation of the offending antifungal agent. CONCLUSION: This retrospective analysis of practices shows that the use of ACT in our paediatric haemato-oncology department is rare, and concerns the most severe cases and/or those not responding to the first line treatment. In most cases, ACT was efficient and well tolerated.

[The treatment of leukaemia in paediatric haematology day hospital]. / Le traitement des leucémies en hôpital de jour d'hématologie pédiatrique.

The paediatric haematology day hospital administers almost all types of chemotherapy used to treat acute lymphoblastic leukaemia. Blood transfusions, myelograms and lumbar punctures are also performed there. The prevention of pain and anxiety generated by the care is a priority.

Capillary gas chromatographic determination of 1,4-butanediol and gamma-hydroxybutyrate in human plasma and urine.

This article describes two methods for the determination of 1,4-butanediol and gamma-hydroxybutyrate in human plasma and urine using capillary gas chromatography. For 1,4-butanediol, plasma or urine samples (500 microl) were extracted by protein precipitation whereas for gamma-hydroxybutyrate, plasma or urine samples (500 microl) were extracted and derivatised with BF3-butanol. The compounds were separated on a Supelcowax-10 column and detection was achieved using a flame ionization detector. The methods are linear over the specific ranges investigated, accurate (with a percentage of the nominal concentration <109.8%) and showed intra-day and inter-day precision within the ranges of 5.0-12.0 and 7.0-10.1%, respectively. No interferences were observed in plasma and urine from hospitalized patients.