Epidemiology of invasive fungal diseases in children with solid tumours undergoing autologous haematopoietic stem cell transplantation: a 10‐year experience in a tertiary Italian centre

Abstract

The objective of the study was to determine the incidence of invasive fungal disease (IFD) in children undergoing autologous haematopoietic stem cell transplantation (auHSCT) for solid tumours (ST). Retrospective study on auHSCT was performed in children with ST (January 2006-December 2015). Data on the number of patient-days at risk (pdr) during the first 30 and 90 days after auHSCT and cases of proven/probable IFDs were collected. Infection rate (IR, episodes/1000 pdr) and proportions and cumulative risk (CR) of IFD were evaluated. In 186 patients, 270 auHSCT were performed, for a total of 8327 pdr during the first 30 days and 24 366 up to day 90. Median age was 5 years (interquartile range 2;8), 63% were male. At day 30, seven procedures were complicated by IFD, with an IR of 0.84 (95% CI 0.66-1.02) and aCR of 2.6% (95% CI 1.4-5.4) at 18 days after HSCT. Within day 90, two further IFDs were detected with an IR of 0.37 (95% CI -0.49 to 1.23) and a CR of 3.3% (95% CI 1.7-6.3) at day 69. Children undergoing auHSCT for ST have a low incidence of IFDs in the first 90 days after the procedure.

Epidemiology and management burden of invasive fungal infections after autologous hematopoietic stem cell transplantation: 10‐year experience at a European Pediatric Cancer Center

“…Similar to other paediatric populations at risk to develop IFDs, the natural incidence of proven and probable IFDs following autologous HSCT in children and adolescents is difficult to determine due to the widespread use of primary antifungal prophylaxis and empirical antifungal therapy and different practices among institutions to pursue a microbiological diagnosis. Considering these limitations, contemporary incidence rates of proven or probable IFDs range from 0% to 5.2% , , and those of possible mould infections, if analysed, from 0% to 11.8% . The absence of proven or probable IFDs and the rate of 8.7% of possible mould infections observed in our analysis are well in line with the published experience and comparable to these studies as both patient population and key indices of transplant‐associated morbidity such as time to neutrophil engraftment, rates of invasive bacterial infections, and overall mortality through day + 30, are very similar.…”

“…Since the number of paediatric patients with an indication for autologous HSCT is comparatively low, epidemiological data for IFDs is limited. Among 12 paediatric studies with retrievable incidence data published from 2000 onward and covering the period between 1986 and 2016, rates of proven and probable IFDs within the first 100 days postautologous HSCT ranged from 0% to 8% , and those of possible IFDs from 0 to 11.8 with median rates of 3 and 2.5%, respectively; the relative proportions of yeast and mould IFDs among the proven and probable cases was variable. More contemporary larger studies including both autologous and allogeneic HSCT recipients transplanted mostly in or after 2000 document a lower overall incidence of proven and probable IFDs after autologous HSCT (5.2%, 2.6%, 5% vs 15.5%, 13.9%, 13.0%, respectively) and a lower overall mortality rate compared with allogeneic HSCT where reported .…”

“…Few studies specifically focused on the infectious morbidity in paediatric patients postautologous HSCT, assessing infection rates for epidemiological purposes or as endpoints of interventional studies, or specifically assessing the epidemiology of IFD in this setting …”

“…Overall mortality at 90 days post‐transplant was 1.4%. No information was given on time to engraftment, overall infectious morbidity and antifungal consumption …”