Antifungal Therapy in Pediatric Acute Lymphoblastic Leukemia: A Single-center Experience

Abstract

Introduction: Invasive fungal infections (IFIs) are significant causes of morbidity and mortality in leukemia patients. This study investigated antifungal treatment and prophylaxis features according to leukemia risk groups and treatment phases in pediatric acute lymphoblastic leukemia (ALL) patients who received Berlin-Frankfurt-Munster-based protocols.Materials and Methods: We retrospectively examined ALL patients' data between the ages of 1 and 18 and treated them with Berlin-Frankfurt-Munster-ALL protocols between June 2013 and December 2016.Results: A total of 446 febrile neutropenic attacks in 85 children were evaluated. Seventy-two patients received antifungals in 151 infection attacks, while 13 patients did not receive any antifungal treatment during chemotherapy. Empirical, preemptive, or proven treatments were given to 74.8%, 21.2%, and 4% of patients, respectively. The frequency of antifungal therapy increased linearly and significantly from the standard-risk group to the intermediaterisk (IR) group, high-risk (HR) group, and relapsed group. IR patients needed more antifungal therapy while receiving induction, whereas HR patients needed more throughout the induction and HR consolidation blocks than other phases. During induction, IR patients received antifungal therapy similar to HR patients' treatment in the induction and HR consolidation blocks.Conclusions: Antifungal therapy requirements increased as the severity and intensity of chemotherapy increased for all leukemia risk groups. The requirement of antifungal therapy for IR patients receiving induction was similar to that of HR patients; further studies are needed to evaluate the potential advantages of using primary antifungal prophylaxis in IR patients.

The Bloody Crossroads: Interactions between Periodontitis and Hematologic Diseases

“…Salivary gland dysfunction manifesting as xerostomia [ 88 , 90 , 91 , 92 ] exacerbates these challenges by altering saliva’s consistency and reducing its protective properties, which are necessary to maintain oral health. This change predisposes individuals to a more frequent occurrence of opportunistic infections, such as candidiasis [ 88 , 93 ], and increased acidity in the oral cavity favors a cariogenic environment, increasing the risk of dental caries [ 88 , 89 ].…”

Oral Manifestations: A Warning-Sign in Children with Hematological Disease Acute Lymphocytic Leukemia

“…Cytomegalovirus, Adenovirus and Epstein–Barr virus can also appear [ 39 ]. In all cases, various topical and systemic antifungal agents can be used: nystatin, clotrimazole and ketoconazole in the first case or fluconazole, itraconazole or ketoconazole in the second situation [ 47 ].…”