Proven and probable invasive fungal infections in children with acute lymphoblastic leukaemia: results from an university hospital, 2005–2013

Abstract

Despite improvements in diagnosis and treatment, invasive fungal infections (IFIs) are still a major cause of morbidity and mortality in immunocompromised patients. The data on IFI among children with acute lymphoblastic leukaemia (ALL) are still scarce, and our aim was to estimate the risk, aetiology and outcome of proven and probable IFIs in children with ALL who did not receive primary prophylaxis over an 8-year period. Between January 2005 and February 2013, 125 children who were treated for ALL at the Pediatric Hematology Department of the Medical School of Ege University were retrospectively reviewed. Proven and probable IFIs were defined according to revised definitions of the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group. The proven and probable IFI incidence was 30/125 (24%). Profound neutropenia was detected in 18 (60%) patients, and prolonged neutropenia was detected in 16 (53.3%) of the patients. The most isolated agents were non-albicans Candida spp. The crude and attributable mortality was 20% and 13.3% respectively. Profound neutropenia was associated with mortality (P < 0.05). The younger patients were especially at risk for proven IFI. Prolonged neutropenia, to be in the induction phase of chemotherapy, and profound neutropenia were found to be the most common predisposing factors for IFI episodes.

Mucormycosis in children with haematological malignancies is a salvageable disease: a report from the Israeli Study Group of Childhood Leukemia

“…Several studies investigating invasive fungal infections in children reported lower rates of mucormycosis than found here (Castagnola et al , ; Johnston et al , ; Sahbudak Bal et al , ; Bochennek et al , ; Inaba et al , ). Yet, rates of invasive fungal infections are known to vary widely between studies (Hale et al , ; Sahbudak Bal et al , ; Pana et al , ; Cesaro et al , ), as a result of different treatment regimens, supportive care policies, study periods (Bochennek et al , ) and geoclimatic factors (Pagano et al , ; Panackal et al , ; Pana et al , ). Our findings underline the importance of obtaining population‐based data from different geographic regions in order to further understand the impact of unique environmental factors on Zygomycetes exposure and pathogenesis.…”

An unappreciated role for neutrophil-DC hybrids in immunity to invasive fungal infections

“…Invasive fungal infections are a leading cause of death in cancer and transplant patients [ 20 – 25 ], and in patients requiring intensive care [ 18 ]. Treatment of deadly fungal infections relies heavily on antifungal drugs, but antifungals have limitations in bioavailability, drug resistance and toxicity [ 26 ].…”

“…In heart and lung transplant recipients, incidence rates of invasive fungal infections are as high as 25%, with 90-day mortality rates of 23% [ 21 , 22 ]. In patients with hematological malignancies, rates of serious fungal infection reach 18%, and mortality rates, 20–30% [ 23 – 25 ].…”

Successful treatment of cerebral aspergillosis: case report of a patient with T-cell large granular lymphocytic leukemia (T-LGL)

“…EORTC guidelines distinguish between possible, probable and proven fungal infection as infection can only be proven in <50% of all cases [ 15 ]. Uncertainty on our patient’s aspergillosis diagnosis remained until histologic proof was obtained.…”