Invasive fungal infections in children with acute lymphoblastic leukaemia: Results from four Australian centres, 2003‐2013

Abstract

Background: Invasive fungal infections (IFI) are an important complication of acute lymphoblastic leukaemia (ALL) treatment. Our study describes the prevalence and outcomes of IFI in children with ALL. Methods: IFI episodes in children with primary or relapsed ALL, identified for The Epidemiology and Risk Factors for Invasive Fungal Infections in Immunocompromised Children study, were analysed. IFI were classified according to European Organization for Research and Treatment of Abbreviations: ALL, acute lymphoblastic leukaemia; CCG, Children'

Comment on: Invasive fungal infections in children with acute lymphoblastic leukemia

“…IFD occurred during induction phase IA in six patients (three HR and three non-HR patients), induction phase IB in one non-HR patient, and after HR-3-Block in two HR patients, with a median time between diagnosis and IFD of 1.6 months (IQR 1.1-4.2) in HR and 1.1 (IQR 0.9-1.4) in non-HR patients. These results are consistent with those fromthe Australian study and underlines that HR ALL in the first phases of chemotherapy presents a high risk of IFD 1.…”

“…International guidelines recommend administration of systemic, mold active antifungal prophylaxis when the incidence of IFD is >10%, and therefore, according to the results of the Australian study and the present data, mold active antifungal prophylaxis could be administered to children with primary nonrelapsing/resistant HR ALL since the beginning of chemotherapy . Posaconazole has been demonstrated effective for this indication in adults and even if not still registered in children, there is availability of pediatric dosages according to age and weight, but the risk of severe interactions with vinca alkaloids, which are a cornerstone of pediatric ALL therapy, contraindicates its use .…”

“…To the Editor: We read with great interest the recent paper on epidemiology of invasive fungal disease (IFD) in children with acute lymphoblastic leukemia (ALL), especially the part concerning the diagnosis of IFD in patients with primary, nonrelapsing/resistant disease. 1 Our Australian colleagues reported 14.5% (95% confidence interval [95%CI] 10.9-19.0) IFD prevalence in high-risk (HR) ALL and 7.3% International guidelines recommend administration of systemic, mold active antifungal prophylaxis when the incidence of IFD is >10%, and therefore, according to the results of the Australian study and the present data, mold active antifungal prophylaxis could be administered to children with primary nonrelapsing/resistant HR ALL since the beginning of chemotherapy. 1,4 Posaconazole has been demonstrated effective for this indication in adults and even if not still registered in children, there is availability of pediatric dosages according to age and weight, but the risk of severe interactions with vinca alkaloids, which are a cornerstone of pediatric ALL therapy, contraindicates its use.…”

“…1 Our Australian colleagues reported 14.5% (95% confidence interval [95%CI] 10.9-19.0) IFD prevalence in high-risk (HR) ALL and 7.3% International guidelines recommend administration of systemic, mold active antifungal prophylaxis when the incidence of IFD is >10%, and therefore, according to the results of the Australian study and the present data, mold active antifungal prophylaxis could be administered to children with primary nonrelapsing/resistant HR ALL since the beginning of chemotherapy. 1,4 Posaconazole has been demonstrated effective for this indication in adults and even if not still registered in children, there is availability of pediatric dosages according to age and weight, but the risk of severe interactions with vinca alkaloids, which are a cornerstone of pediatric ALL therapy, contraindicates its use. 5 Voriconazole (intravenous or oral) or, probably better, liposomal amphotericin B, which does not present significant risks of interactions, administered two times-a-week intravenously can represent acceptable alternatives in this setting.…”

“…To the Editor: We read with great interest the recent paper on epidemiology of invasive fungal disease (IFD) in children with acute lymphoblastic leukemia (ALL), especially the part concerning the diagnosis of IFD in patients with primary, nonrelapsing/resistant disease . Our Australian colleagues reported 14.5% (95% confidence interval [95%CI] 10.9‐19.0) IFD prevalence in high‐risk (HR) ALL and 7.3% (95%CI 4.5‐10.2) in non‐HR.…”