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Invasive fungal infections in paediatric acute myeloid leukaemia
D L Johnston1, V Lewis, R Yanofsky
1Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. djohnston@cheo.on.ca
Abstract:
Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in paediatric acute myeloid leukaemia (AML). This study describes risk factors for IFI and IFI-related sepsis in this population. We conducted a population-based, retrospective cohort study of children with AML in Canada. IFIs during chemotherapy and prior to haematopoietic stem cell transplantation, relapse, persistent disease or death were identified. Risk factors for proven or probable IFI were examined. Among courses complicated by IFI, risk factors for sepsis were also evaluated. There were 341 children with AML included of which 41 (12.0%) experienced 46 different episodes of IFI. Candida species accounted for 23 (50.0%) of IFIs and Aspergillus spp. accounted for 14 (30.4%). Days of broad-spectrum antibiotics, days of corticosteroids and neutropenia at start of the course were independently associated with IFI. Only days of fever were independently associated with IFI-related sepsis. Invasive fungal infections occurred in 12.0% of paediatric AML patients. Risk factors for IFI and IFI-related sepsis were identified. This knowledge may help to consider targeted strategies.
Insights
Invasive fungal infections (IFIs) affect 12% of children with acute myeloid leukaemia (AML). Broad-spectrum antibiotics, corticosteroids, and neutropenia increase IFI risk, while fever predicts IFI-related sepsis in these patients.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Invasive fungal infections (IFIs) are a significant cause of illness and death in children with acute myeloid leukaemia (AML).
- Understanding risk factors for IFIs and associated sepsis is crucial for improving outcomes in this vulnerable population.
Purpose of the Study:
- To identify risk factors for proven or probable invasive fungal infections (IFIs) in pediatric acute myeloid leukaemia (AML) patients.
- To examine risk factors for IFI-related sepsis among pediatric AML patients experiencing IFIs.
Main Methods:
- A population-based, retrospective cohort study was conducted.
- Data from 341 children with AML in Canada were analyzed.
- IFIs occurring during chemotherapy and prior to stem cell transplantation were identified and risk factors evaluated.
Main Results:
- 12.0% of pediatric AML patients (41 out of 341) experienced 46 episodes of IFIs.
- Candida species (50.0%) and Aspergillus spp. (30.4%) were the most common pathogens.
- Independent risk factors for IFI included days of broad-spectrum antibiotics, days of corticosteroids, and neutropenia at the start of chemotherapy.
- Days of fever were independently associated with IFI-related sepsis.
Conclusions:
- Invasive fungal infections are a considerable complication in pediatric AML, occurring in 12.0% of patients.
- Specific factors like antibiotic use, corticosteroid exposure, neutropenia, and fever are linked to IFI and sepsis development.
- Identifying these risk factors can inform targeted preventative and therapeutic strategies for IFIs in pediatric AML.
