Muscle weakness is one of the most serious problems during chemotherapy for childhood hematological malignancies. It may be caused by long-term hospitalization, unfavorable physical conditions, and restricted activities. Although the concept of sarcopenia is becoming widely recognized, especially in geriatric medicine, there have been few reports about sarcopenia in pediatric patients with hematological malignancies. A total of 47 consecutive first-onset acute lymphoblastic leukemia (ALL) patients who underwent induction therapy between January 2011 and September 2016 were investigated. The cross-sectional psoas muscle area (PMA) was measured on computed tomography (CT) images. PMA changes were expressed as the Muscle Loss Index (MLI), which was calculated by dividing the post-treatment PMA by the pre-treatment PMA. In this study, patients with values less than the lowest quartile of MLI were classified into the sarcopenia group, and their basic and clinical factors were compared with those in the non-sarcopenia group. Muscle loss was observed in all patients after induction therapy, and severe adverse events during induction therapy were significantly more common in patients in the sarcopenia group. Furthermore, sarcopenia was found to be an independent prognostic factor for invasive fungal infection (IFI) that occurs after induction therapy. The evaluation of sarcopenia on CT images is easy and useful as a predictor of unfavorable events such as IFI in the treatment of childhood ALL.

Infection, especially invasive fungal infection (IFI), is an important complication of chemotherapy and stem cell transplantation. It is also a well-known risk factor in pediatric hematologic malignancy, acute myelogenous leukemia, recurrent disease and allogeneic stem cell transplantation. We previously revealed that a diagnosis of acute myelogenous leukemia, recurrent disease and >10 years of age were risk factors for IFI in patients with pediatric hematologic malignancies. We examined and compared the incidence, risk factors and mortality rate from IFI between 276 patients from 2007 to 2016 and patients in our past report. The cumulative incidence of IFI was 10.5%; this comprised cases of probable and possible IFI at rates of 5.1% and 5.4%, respectively. Univariate analysis showed that age >9 years at admission, recurrent disease and acute myelogenous leukemia diagnosis were risk factors for IFI. Similar to the results of the previous study, multivariate analysis showed that each of these 3 variables was an independent predictor of IFI. The survival rate was lower in patients with IFI than in those without IFI (38.8% versus 69.9%; P < 0.001). However, IFI was a direct cause of death in only 2 patients. Although 11 patients received stem cell transplantation after IFI treatment, only 2 patients have survived, and the other 9 patients died of other complications.

Stem cell transplantation could reduce the mortality of patients with hematologic disease who develop mucormycosis.

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Pediatric patients with acute myeloid leukemia (AML) are at high risk of invasive fungal infection (IFI). In adult patients, the D-index, which reflects the duration and intensity of neutropenia, was reported as a predictive factor of IFI after induction therapy for AML. The aim of this study was to assess whether the D-index is a predictive factor for IFI in pediatric AML. We define the D-index as the area over the neutrophil curve during neutropenia. Ninety-two courses of chemotherapy performed for 24 consecutive patients with AML undergoing chemotherapy at Sapporo Hokuyu Hospital between April 2007 and March 2017 were analyzed. We also evaluated the utility of the cumulative D-index (c-D-index) from the start of neutropenia until the clinical manifestation of IFI in these patients. The D-index and c-D-index were compared between courses with and without IFI episodes. The median D-index and c-D-index in 6 courses with IFI episodes were 12,816 (range 9500-27,412) and 7250 (range 3987-16,273), respectively, which was not statistically higher than the median D-index [10,127 (range 3788-20,897)] in 86 courses without IFI episodes (P = 0.081 and P = 0.108, respectively). Unlike in adult cases, neither the D-index nor c-D-index reflected the risk of IFI in pediatric AML.