{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T16:26:01Z","timestamp":1780590361073,"version":"3.54.1"},"reference-count":29,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2017,3,23]],"date-time":"2017-03-23T00:00:00Z","timestamp":1490227200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006058","name":"St. Baldrick's Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006058","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2017,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Antifungal prophylaxis is recommended for patients with acute lymphoblastic leukemia (ALL) during high\u2010risk periods such as induction; however, increased vincristine toxicities have been reported with the co\u2010administration of triazole antifungals. We sought to determine whether vincristine\u2010associated toxicities are higher among children with ALL concurrently given fluconazole prophylaxis compared to no prophylaxis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>Using a retrospective cohort design, we reviewed records of pediatric patients treated for newly diagnosed ALL from 2003 to 2013. Patients were classified by fluconazole exposure during induction. The development of vincristine\u2010associated toxicity and vincristine dose adjustment were the primary outcomes evaluated. The adjusted risk difference (RD) for vincristine\u2010related toxicity associated with triazole exposure was determined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 197 patients meeting inclusion criteria for evaluation, 160 (81%) of whom received fluconazole prophylaxis. Among patients receiving fluconazole, 36\/160 (22%) developed vincristine toxicity compared to 7\/37 (19%) among those not receiving prophylaxis (RD: 3%, 95% confidence interval [CI] \u221211 to 18%). Adjusting for patient age and race, no statistically significant increased risk for vincristine\u2010associated toxicity with fluconazole exposure was observed (RD 5%, 95% CI \u22128 to 17%). An increased risk for vincristine\u2010associated toxicity was independently associated with age 10 years or older (RD 19%, 95% CI 4\u201334%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Co\u2010administration of fluconazole during induction therapy for pediatric ALL does not significantly increase the risk for vincristine\u2010associated toxicities; however, patients 10 years or older are at an increased risk for toxicity independent of fluconazole exposure. Prophylaxis with fluconazole during induction therapy for pediatric ALL, if warranted, appears to be a safe clinical practice.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.26525","type":"journal-article","created":{"date-parts":[[2017,3,24]],"date-time":"2017-03-24T09:02:02Z","timestamp":1490346122000},"source":"Crossref","is-referenced-by-count":15,"title":["Vincristine toxicity with co\u2010administration of fluconazole during induction therapy for pediatric acute lymphoblastic leukemia"],"prefix":"10.1002","volume":"64","author":[{"given":"Andrew B.","family":"Smitherman","sequence":"first","affiliation":[{"name":"Division of Pediatric Hematology\/Oncology  Chapel Hill North Carolina"},{"name":"UNC Lineberger Comprehensive Cancer Center  Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassidy B.","family":"Faircloth","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, UNC Hospitals  Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Deal","sequence":"additional","affiliation":[{"name":"UNC Lineberger Comprehensive Cancer Center  Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Troy","sequence":"additional","affiliation":[{"name":"UNC School of Medicine  Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart H.","family":"Gold","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hematology\/Oncology  Chapel Hill North Carolina"},{"name":"UNC Lineberger Comprehensive Cancer Center  Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,3,23]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199305063281808"},{"key":"e_1_2_7_3_1","unstructured":"National Comprehensive Cancer Network.Prevention and treatment of cancer\u2010related infections (version 2.2016).https:\/\/www.nccn.org\/professionals\/physician_gls\/PDF\/infections.pdf. Accessed August 1 2016."},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa061094"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01974614"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01697985"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(95)92816-2"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2257.1998.00103.x"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/088800101300002973"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.2001.tb03257.x"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00043426-200210000-00023"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-1754.2003.00255.x"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mph.0000172751.06286.5b"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPH.0b013e318030d289"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1751-553X.2007.00918.x"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPH.0b013e31819b9d01"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.22399"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.22972"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/1078155208101959"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkr223"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.3109\/08880018.2011.624163"},{"key":"e_1_2_7_22_1","volume-title":"Diflucan\u00ae [package insert]","year":"2014"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1211\/0022357056118"},{"key":"e_1_2_7_24_1","doi-asserted-by":"crossref","unstructured":"NiwaT ImagawaY YamazakiH.Drug interactions between nine antifungal agents and drugs metabolized by human cytochrome P450 Curr Drug Metab.2014;15:651\u2013679.","DOI":"10.2174\/1389200215666141125121511"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2013.09.018"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/jns.12114"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.22882"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.21435"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.22845"},{"key":"e_1_2_7_30_1","unstructured":"ScienceM RobinsonPD MacDonaldT Rassekh SR DupuisLL SungL.Guideline for primary antifungal prophylaxis for pediatric patients with cancer or hematopoietic stem cell transplant recipients. Edmonton Alberta Canada: C17 Council;2014."}],"container-title":["Pediatric Blood &amp; Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fpbc.26525","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pbc.26525","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T22:10:31Z","timestamp":1696025431000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pbc.26525"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,3,23]]},"references-count":29,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2017,10]]}},"alternative-id":["10.1002\/pbc.26525"],"URL":"https:\/\/doi.org\/10.1002\/pbc.26525","archive":["Portico"],"relation":{},"ISSN":["1545-5009","1545-5017"],"issn-type":[{"value":"1545-5009","type":"print"},{"value":"1545-5017","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,3,23]]},"article-number":"e26525"}}