Invasive Fungal Infections in Children With Acute Myeloid Leukemia: A Single-center Experience Over 19 Years
Küçük Resim Yok
Tarih
2023
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Lippincott Williams and Wilkins
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
Objective: Invasive fungal infections (IFIs) remain a significant cause of morbidity and mortality in children with acute myeloid leukemia (AML). This study aimed to evaluate the incidence, risk factors, etiology, and outcome of IFIs in children with AML and the effect of mold-active antifungal prophylaxis. Materials and Methods: We retrospectively reviewed pediatric patients treated for AML between January 2004 and December 2022. Proven, probable, or possible IFIs were defined using standardized definitions of the European Organization for the Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) classification published at 2008. Results: A total of 298 febrile neutropenia episodes from 78 patients were evaluated. Proven, probable, and possible IFI rates were 3%, 2.6%, and 9.4%, respectively. Profound neutropenia was detected in 18 (58%) and prolonged neutropenia in 20 (64.5%) of the IFI episodes. Invasive aspergillosis accounted for the majority of IFI episodes; however, non-albicans Candida spp. were the most isolated pathogens in the proven group. Patients with relapsed AML were particularly at risk for the development of IFI (P=0.02). A significant decrease in IFI episodes was achieved with mold-active antifungal prophylaxis with voriconazole (P=0.01, odds ratio: 0.288, %95 CI:0.104-0.797). The overall mortality was 35.8%, and the IFI-attributable mortality rate was 25%. In the multivariate analysis, relapsed disease was the most significant risk factor associated with mortality (P=0.006, odds ratio:4.745; 95% CI: 1.573-14.316). Conclusion: Mold-active prophylaxis reduced the rate of IFIs in this cohort however IFI-related mortality was still high as 25% in pediatric AML patients. Relapsed AML was the most significant risk factor associated with mortality. © 2023 Lippincott Williams and Wilkins. All rights reserved.
Açıklama
Anahtar Kelimeler
acute myeloid leukemia, child, febrile neutropenia, invasive fungal infection, alemtuzumab, amikacin, amphotericin B, caspofungin, cyclosporine, galactomannan, host factor, meropenem, piperacillin plus tazobactam, prednisone, voriconazole, Acremonium, acute myeloid leukemia, adolescent, age, antifungal susceptibility, Article, aspergillosis, Candida, Candida albicans, Candida glabrata, Candida parapsilosis, child, computer assisted tomography, enzyme immunoassay, febrile neutropenia, female, fungemia, human, incidence, Kluyveromyces marxianus, leukemia relapse, Magnusiomyces capitatus, major clinical study, male, mortality rate, neutropenia, neutrophil count, outcome assessment, pneumonia, prophylaxis, retrospective study, risk factor, school child, sepsis, systemic mycosis, Trichosporon asahii
Kaynak
Journal of Pediatric Hematology/Oncology
WoS Q Değeri
Scopus Q Değeri
Q3
Cilt
45
Sayı
7
