Aspergillus flavus Infections in Children With Leukemia Despite Liposomal Amphotericin-B Prophylaxis

Area of Science:

• Pediatric Oncology
• Infectious Diseases
• Mycology

Background:

• Liposomal amphotericin-B (L-AmB) is utilized for antifungal prophylaxis in pediatric leukemia patients when azoles are contraindicated.
• The efficacy of L-AmB prophylaxis in preventing invasive fungal infections, specifically aspergillosis, in this high-risk population remains a subject of debate.

Purpose of the Study:

• To evaluate the effectiveness of L-AmB prophylaxis at a dose of 2.5 mg/kg twice weekly in preventing invasive aspergillosis in children with high-risk leukemia.
• To identify specific Aspergillus species that may be less susceptible to L-AmB prophylaxis.

Main Methods:

• A retrospective review of medical records was conducted for children diagnosed with high-risk leukemia between 2012 and 2019.
• Cases of proven or probable invasive aspergillosis occurring despite L-AmB prophylaxis were identified and analyzed.

Main Results:

• Invasive aspergillosis was diagnosed in 10 out of 62 (16%) children receiving L-AmB prophylaxis.
• The data suggest that L-AmB prophylaxis provided insufficient protection against invasive aspergillosis.
• Aspergillus flavus was identified as a particular challenge, with infections occurring despite prophylaxis.

Conclusions:

• Liposomal amphotericin-B prophylaxis at the studied dosage and frequency is not sufficiently effective in preventing invasive aspergillosis in children with high-risk leukemia.
• The findings highlight the need for alternative or adjunctive strategies to improve antifungal protection, especially against Aspergillus flavus, in this vulnerable patient group.