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.