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Invasive fungal infections in pediatric leukemia patients receiving fluconazole prophylaxis

Zuhre Kaya1, Turkiz Gursel, Ulker Kocak

  • 1Pediatric Hematology Unit of Department of Pediatrics, Medical School of Gazi University, Ankara, Turkey. zuhrekaya@gazi.edu.tr

Pediatric Blood & Cancer
|December 6, 2008
PubMed
Abstract

Insights

Long-term antifungal prophylaxis (AFP) with fluconazole may reduce invasive fungal infections (IFI) in children with acute leukemia. Early antifungal therapy also appears effective in lowering IFI incidence and mortality.

Area of Science:

  • Pediatric Oncology
  • Infectious Diseases
  • Hematology

Background:

  • Children with acute leukemia face a high risk of invasive fungal infections (IFI).
  • The impact of long-term antifungal prophylaxis (AFP) on IFI morbidity and mortality in this population is not well-established.
  • This study investigates the role of fluconazole-based AFP in pediatric acute leukemia.

Purpose of the Study:

  • To determine the risk factors, clinical characteristics, and outcomes of IFI in children with acute leukemia receiving AFP.
  • To evaluate the effectiveness of fluconazole prophylaxis and early empirical antifungal therapy in managing IFI.
  • To assess the incidence and mortality rates associated with IFI in this patient group.

Main Methods:

  • Retrospective review of medical records for 154 children with acute leukemia undergoing intensive chemotherapy with fluconazole AFP.
  • Analysis of IFI incidence, causative agents (Candida, Aspergillus), and specific infection types (candidemia, aspergillosis).
  • Evaluation of risk factors including neutropenia and steroid use, and treatment outcomes with Liposomal amphotericin B and Voriconazole.

Main Results:

  • The overall incidence of IFI was 13.6%, with Candida and Aspergillus as primary pathogens.
  • IFI was more common in acute myeloid leukemia (AML) than acute lymphoblastic leukemia (ALL).
  • Profound neutropenia and steroid use were associated with IFI; 5% of deaths were attributable to IFI.

Conclusions:

  • Antifungal prophylaxis with fluconazole and early empirical antifungal treatment may effectively reduce IFI incidence and mortality in pediatric acute leukemia.
  • Liposomal amphotericin B and Voriconazole showed success in treating various fungal infections.
  • Further research into optimal antifungal strategies for immunocompromised pediatric patients is warranted.

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