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. 2025 Nov 7;11(11):797.
doi: 10.3390/jof11110797.

Real-Life Use of Posaconazole in Clinical Practice for Onco-Hematological Children: A National Survey by AIEOP Infectious Diseases Working Group

Lorenzo Chiusaroli  1 , Manuela Spadea  2 , Cecilia Liberati  1 , Maria Grazia Petris  3 , Antonio Grasso  4 , Francesco Baccelli  4 , Maria Vittoria Micheletti  5 , Pietro Gasperini  6 , Maria Rosaria D'Amico  7 , Katia Perruccio  8 , Angelica Barone  9 , Daniela Onofrillo  10 , Paola Muggeo  11 , Maura Faraci  12 , Simona Rinieri  13 , Ilaria Liguoro  14 , Antonella Colombini  15 , Francesca Trevisan  16 , Nagua Giurici  17 , Gianluca Boscarol  18 , Letizia Pomponia Brescia  19 , Alessia Pancaldi  20 , Francesca Compagno  21 , Alessandra Biffi  3 , Daniele Donà  1 , Simone Cesaro  22
Affiliations

Real-Life Use of Posaconazole in Clinical Practice for Onco-Hematological Children: A National Survey by AIEOP Infectious Diseases Working Group

Lorenzo Chiusaroli et al. J Fungi (Basel). .

Abstract

Background: Posaconazole is an antifungal medication used to treat invasive fungal infections (IFI) in pediatric onco-hematological patients. Its approval for pediatric use was recent, and limitations still apply. Despite limited data, the safety and efficacy profile appear generally favorable in children. This study describes how posaconazole is used across centers affiliated with the Associazione Italiana Ematologia e Oncologia Pediatrica (AIEOP).

Methods: A national survey was conducted among physicians within the AIEOP network to evaluate current use of posaconazole in pediatric cancer patients, including those undergoing hematopoietic stem cell transplantation (HSCT). A 25-item web questionnaire was developed and distributed in June 2024. Data analysis involved descriptive statistics.

Results: Twenty-one of thirty-one centers (68%) responded, reporting availability of various posaconazole formulations: oral suspension (76%), delayed-release tablets (95%), and intravenous solution (14%). Posaconazole was primarily used for prophylaxis in patients with acute lymphoblastic leukemia (ALL, 38%), acute myeloid leukemia (AML, 38%), and aplastic anemia (19%). It was also used as secondary prophylaxis against previous possible or probable IFI or as salvage therapy for probable or confirmed aspergillosis or mucormycosis, often combined with other treatments. Drug plasma level monitoring was common but varied in scheduling across centers. Most centers (74%) discontinued posaconazole if adverse events suspected drug-drug interactions, such as with vincristine.

Conclusions: Posaconazole is widely used in AIEOP centers, though application varies significantly. This variability emphasizes the need for prospective studies to better define indications, dosing, and monitoring protocols for pediatric use of this antifungal.

Keywords: children; fungal infections; posaconazole; survey.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Dosage schemes adopted among the centers according to our Survey. TID: three times daily. BID: twice daily. Note: 8/21 centers did not provide the exact dosage and are excluded. Percentages are calculated among the 13 reporting centers.
Figure 2
Figure 2
Number of centers where Posaconazole is used for treatment. For this item, the center could select one or more options. Combined therapy refers to combination with other antifungal agents.
See this image and copyright information in PMC

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