Epidemiology and outcome of invasive fungal disease in children after hematopoietic cell transplantation or treated for malignancy: Impact of national programme of antifungal prophylaxis

Abstract

Summary The objective of the study was the analysis of incidence and outcome of invasive fungal disease (IFD) in children treated for malignancy (PHO, paediatric hematology‐oncology) or undergoing hematopoietic cell transplantation (HCT) over a period of six consecutive years in nationwide study. A total number of 5628 patients with newly diagnosed malignancies and 971 patients after HCT (741 allo‐HCT and 230 auto‐HCT) were screened for infectious complications in biennial reports. IFD incidence was lower among PHO patients: 8.8% vs 21.2% (P < .0001) and survival from IFD was better: 94.2% vs 84.1% (P < .0001). Auto‐HCT patients had lower incidence (10.9% vs 24.4%) and lower mortality than allo‐HCT patients. Introduction of national antifungal prophylaxis programme in HCT and acute leukaemia patients decreased incidence of IFD in HCT (from 23.1% to 13.4%) and AML on conventional chemotherapy (from 36% to 23%) but not in ALL patients during chemotherapy. In multivariate analysis, the incidence of IFD was higher in patients after HCT, diagnosed for ALL, AML or NHL, and in patients > 10 years old. Factors contributing to death with infection were as follows: undergoing HCT, diagnosis of acute leukaemia (ALL or AML) and duration of treatment of infection > 21 days. In conclusion, the incidence of IFD in allo‐HCT and in AML patients on chemotherapy has decreased after introduction of national programme of antifungal prophylaxis, while the incidence of IFD in ALL patients on chemotherapy did not change significantly. The outcome of IFD both in PHO and HCT patients has largely improved in comparison with historical international data.

Acute non-hematological toxicity of intensive chemotherapy of acute lymphoblastic leukemia in children

“…In our analysis, both absolute number and their rate per 1 patient has increased over the years. It should be noted that between 2014 and 2015, antifungal prophylaxis with azoles was introduced in Poland; however, due to their interaction with vincristine it does not decrease the rate of fungal infections in children with ALL [20]. Antimicrobial prophylaxis in pediatric ALL is not recommended [21,22], and children are more susceptible to infectious complications than adults [23].…”

Antimicrobial prophylaxis in patients after hematopoietic cell transplantation: results of a survey of the Polish Federation of Bone Marrow Transplant Centers

“…early and early posttransplant phase [2][3][4][5][6]; however, No Bioethical Committee agreement was necessary for this study, as no patients were involved. All participants of the survey are coauthors of this manuscript and they gave their agreement for publication.…”

Clinical spectrum and outcome of invasive mucormycosis in children and adults: Polish experience of the decade 2010–2019

“…This project was widened to include the adult hematopoietic transplant setting for the period 2012-2014. The overall results of this national project were presented elsewhere [8,9,10].…”

“…Organization for the Research and Treatment of Cancer/ Mycosis Study Group (EORTC/MSG) as proven, probable, or possible in the 2002 and 2008 versions, and finally revised and updated according to the new 2019 criteria[11]. All HCT and PHO patients were screened with the galactomannan test mainly during neutropenia or on the basis of clinically driven indications[8,9,10].…”