Management of Invasive Fungal Infections in Pediatric Acute Leukemia and the Appropriate Time for Restarting Chemotherapy

Abstract

Objective:Rapid and effective treatment of invasive fungal infection (IFI) in patients with leukemia is important for survival. In this study, we aimed to describe variations regarding clinical features, treatment modalities, time of restarting chemotherapy, and outcome in children with IFI and acute leukemia (AL).Materials and Methods:The charts of all pediatric AL patients in our clinic between the years of 2001 and 2013 were retrospectively reviewed. All patients received prophylactic fluconazole during the chemotherapy period.Results:IFI was identified in 25 (14%) of 174 AL patients. Most of them were in the consolidation phase of chemotherapy and the patients had severe neutropenia. The median time between leukemia diagnosis and definition of IFI was 122 days. Twenty-four patients had pulmonary IFI. The most frequent finding on computed tomography was typical parenchymal nodules. The episodes were defined as proven in 4 (16%) patients, probable in 7 (28%) patients, and possible in 14 (56%) patients. The median time for discontinuation of chemotherapy was 27 days. IFI was treated successfully in all patients with voriconazole, amphotericin B, caspofungin, or posaconazole alone or in combination. Chemotherapy was restarted in 50% of the patients safely within 4 weeks and none of those patients experienced reactivation of IFI. All of them were given secondary prophylaxis. The median time for antifungal treatment and for secondary prophylaxis was 26 and 90 days, respectively. None of the patients died due to IFI.Conclusion:Our data show that rapid and effective antifungal therapy with rational treatment modalities may decrease the incidence of death and that restarting chemotherapy within several weeks may be safe in children with AL and IFI.

Frequency of Infectious Mortality at the End of Induction Chemotherapy in Acute Lymphoblastic Leukemia and Lymphoma Patients: Findings From a Tertiary Care Cancer Center

“…Fungal infections pose a significant threat to children with ALL and lymphomas. Previously, the rate of invasive fungal infections among patients with hematological malignancies was reported to be between 1.3-25% [15,16]. However, in the present study, the fungal infection rate was 31%, and among these, three subjects had concurrent positive cultures for bacteremia.…”

Invasive fungal infections in children with leukaemia in a tertiary hospital in Oman, 8-year review.

“…Previous studies have looked at the prevalence of IFIs in pediatric leukemia patients as well as the incidence of hematologic malignancies all over the world. [15][16][17][18][19][20][21][22][23][24][25][26] In pediatric patients, the incidence of invasive fungal infection has been reported to range between 1.7% and 35.4%, and the incidence of invasive fungal infection in our study falls within this range. [15][16][17][18][19][20][21][22][23][24][25][26] Differences in study populations, hospital conditions, use of prophylactic antifungal agents, and IFI definition criteria may explain the disparity between studies.…”

A study on clinical profile of invasive fungal infection in neutropenic children in a tertiary care teaching hospital

“…However, this was different from the study by Tufekci et al where the number of patients was higher in the consolidation phase. 18 The duration (≥7 days) and severity (<100 ANC) of neutropenia directly correlates with the total incidence of all infections and of those infections that are life threatening and both were found to be statistically significant in our study (p<0.05). This was similar to a study by Lin et al where prolonged neutropenia was significantly associated with invasive fungal infections.…”