Epidemiology, utilisation of healthcare resources and outcome of invasive fungal diseases following paediatric allogeneic haematopoietic stem cell transplantation

Abstract

Summary Background Epidemiology and management practices of invasive fungal diseases (IFD) after allogeneic haematopoietic stem cell transplantation (HSCT) are a subject of constant change. We investigated the contemporary incidence, diagnostics, antifungal management and outcome at a major paediatric transplant centre in Germany. Methods The single‐centre retrospective observational study included all paediatric allogeneic HSCT patients (pts) transplanted between 2005 and 2015. Patient‐related data were assessed up to 365 days post‐transplant. The primary endpoint was the incidence of possible, probable and proven IFDs. Secondary endpoints included diagnostics and antifungal treatment; analysis of risk factors; and overall survival with the last follow‐up in January 2017. Results A total of 221 first (196), second (21) or third (4) procedures were performed in 200 pts (median age: 9 years, range, 0.5‐22) for leukaemia/lymphoma (149) and non‐malignant disorders (72). Prophylaxis was administered in 208 HSCT procedures (94%; fluconazole, 116, mould‐active agents, 92). At least one computed tomography scan of the chest was performed in 146, and at least one galactomannan antigen assay in 60 procedures. There were 15 cases of proven (candidemia, 4; aspergillosis, 4) or probable (aspergillosis, 7) IFDs, accounting for an incidence rate of 6.8%. Overall mortality at last follow‐up was 30%; the occurrence of proven/probable IFDs was associated with a reduced survival probability (P < .001). Conclusion Morbidity and mortality from IFDs at our institution were consistent with data reported from other centres. Utilisation of healthcare resources for prevention, diagnosis and management of IFDs was considerable.

A Survival Analysis of Invasive Fungal Diseases in Children with Cancer

“…One explanation is that HSCT is the best chance of cure for diseases like AML, 16 and most of the patients will recover from neutropenia. This mortality rate from IFD is consistent with data reported from other centers, 17 but the cohort of HSCT patients was too small and these statistics may be biased.…”

Changing Epidemiology of Invasive Fungal Disease in Allogeneic Hematopoietic Stem Cell Transplantation

“…As with adults, improvements in medical care have resulted in an increased burden of IFD risk in children undergoing HSCT. Yet, despite the fact that mortality rates have been reported as high as 50-60%, limited data is available regarding epidemiology, treatment, and overall management of IFD in this population [25,26,28].…”

“…IFD incidence rates of approximately 7-16% have been reported in pediatric allogenic HSCT recipients. Most IFD cases (around 50%) occur during pre-engraftment [29], although some series have reported a predominance of cases during the late post-engraftment period [26]. Unlike in adult patients, yeasts and Candida spp.…”

“…Unlike in adult patients, yeasts and Candida spp. particularly remain the most frequent causative agents of IFD in pediatric HSCT recipients [25,26,28]. The second most common causative fungus is Aspergillus spp., which is responsible for most IMD.…”

Invasive Mold Infections in Allogeneic Hematopoietic Cell Transplant Recipients in 2020: Have We Made Enough Progress?

“…As a result, antifungal prophylaxis breakthrough IMIs (bIMIs), associated with dismal outcomes, have been increasingly reported [ 10 , 11 ]. Contemporary data in the era of routine mold-active prophylaxis on the epidemiology and outcomes of IMI in allogeneic HCT recipients are limited [ 5 , 12–15 ]. We sought to describe the incidence, risk factors, and clinical outcomes of IMI in a recent 10-year cohort of allogeneic HCT recipients.…”