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Prevention of fungal infections in ALL

Micafungin given by infusion twice a week reduces the number of fungal infections by ~80% early in the treatment of ALL in children. It is therefore an effective preventive treatment to protect children from these infections. 

Fungal infections are difficult to treat and can cause severe illness and can even be fatal for children with cancer. The Princess Máxima Center is working to improve treatment and to find new approaches to prevent or treat these infections. Didi Bury, a PhD student at the Máxima Center and Radboud UMC, is working on her PhD research in 2018 in a team from the Tissing group on the effect of micafungin in a patient-friendly regimen in children with acute lymphoblastic leukemia (ALL). How can fungal infections in these children be prevented or reduced in the early phase of treatment? 

Twice a week 
In the past, children with ALL have not been given any medications to prevent fungal infections in the early stages of their treatment because they receive the drug vincristine. Vincristine cannot be combined with most drugs used to prevent fungal infections, because these drugs inhibit the metabolism of vincristine, which can cause serious side effects. However, 7-8 children per year develop fungal infections in this early phase of ALL treatment. Didi Bury: ‘We wanted to see if we could reduce the number of fungal infections with a drug called micafungin. This drug can be given at the same time as vincristine, without increasing its side effects. Normally, a child is given micafungin once a day by infusion. This trial looked at the effects when the drug was given twice a week, which is more patient-friendly.’ 

Preventive and effective 
Didi Bury drew conclusions and published the results in a prestigious journal. The results were immediately put into practice. Didi: ‘Twice weekly micafungin reduces the number of fungal infections in the early phase of treatment of ALL in children by ~80%.  It is therefore an effective preventive treatment to protect children from fungal infections. In the Máxima this is now incorporated in the ALLTogether treatment protocol. Future research will need to show whether new drugs with a similar effect can be administered in a more patient-friendly schedule, such as once-weekly or as a tablet or oral fluid.’