Invasive fungal infections (IFI) are an important complication in hematologic malignancies and stem-cell transplantation (SCT). However, there are limited data characterizing IFI in children. The clinical feature of IFI after chemotherapy and SCT were analyzed in 334 pediatric patients treated at Hokkaido University Hospital from 1997 to 2006. The cumulative incidence of IFI was 6.9%; this comprised cases of proven, probable and possible IFI at rates of 1.2%, 3.0%, and 2.7%, respectively. The infected lesions were lung in 14 patients, liver in 5 patients, brain in 3 patients, fungemia in 2 patients, kidney in 1 patient, and endophthalmitis in 1 patient. The mortality of IFI was 48.2%, excluding patients who died due to relapse and interstitial pneumonitis; in particular, 71.4% patients with a lung lesion (10/14) died due to IFI. Fifty-nine pediatric patients died in our institution over the 10-year period of the study and IFI was the direct cause of death in 18.6% (11/59) of the patients. Risk factors for IFI with chemotherapy and SCT were also analyzed. Univariate analysis showed that age at diagnosis older than 10 years, relapse of original disease, long-term administration of broad-spectrum antibiotics, and acute myelogenous leukemia (AML) were the risk factors for IFI. All patients with IFI received long-term antibiotic therapy. AML was most strongly associated using a multivariate analysis. The prognosis of IFI has been expected poor; therefore, prevention of this condition, especially for older patients with AML, would be important.

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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.