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Published on: September 18, 2013
Antifungal Therapy in Pediatric Acute Lymphoblastic Leukemia: A Single-center Experience
Metin Yigit1, Özlem Arman Bilir2, Saliha Kanik Yüksek3
1Pediatrics Department.
Introduction:
Invasive fungal infections (IFIs) are significant causes of morbidity and mortality in leukemia patients. This study investigated antifungal treatment and prophylaxis features according to leukemia risk groups and treatment phases in pediatric acute lymphoblastic leukemia (ALL) patients who received Berlin-Frankfurt-Munster-based protocols.
Materials And Methods:
We retrospectively examined ALL patients' data between the ages of 1 and 18 and treated them with Berlin-Frankfurt-Munster-ALL protocols between June 2013 and December 2016.
Results:
A total of 446 febrile neutropenic attacks in 85 children were evaluated. Seventy-two patients received antifungals in 151 infection attacks, while 13 patients did not receive any antifungal treatment during chemotherapy. Empirical, preemptive, or proven treatments were given to 74.8%, 21.2%, and 4% of patients, respectively. The frequency of antifungal therapy increased linearly and significantly from the standard-risk group to the intermediate-risk (IR) group, high-risk (HR) group, and relapsed group. IR patients needed more antifungal therapy while receiving induction, whereas HR patients needed more throughout the induction and HR consolidation blocks than other phases. During induction, IR patients received antifungal therapy similar to HR patients' treatment in the induction and HR consolidation blocks.
Conclusions:
Antifungal therapy requirements increased as the severity and intensity of chemotherapy increased for all leukemia risk groups. The requirement of antifungal therapy for IR patients receiving induction was similar to that of HR patients; further studies are needed to evaluate the potential advantages of using primary antifungal prophylaxis in IR patients.
Insights
Antifungal treatment needs in pediatric acute lymphoblastic leukemia (ALL) patients rise with chemotherapy intensity. Intermediate-risk (IR) patients require similar antifungal therapy during induction as high-risk (HR) patients.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Invasive fungal infections (IFIs) are a major cause of illness and death in leukemia patients.
- This study focuses on antifungal treatment and prophylaxis in pediatric acute lymphoblastic leukemia (ALL) patients.
Purpose of the Study:
- To investigate antifungal treatment and prophylaxis patterns based on leukemia risk groups and treatment phases.
- To analyze antifungal therapy needs in pediatric ALL patients undergoing Berlin-Frankfurt-Munster protocols.
Main Methods:
- Retrospective analysis of pediatric ALL patients (ages 1-18) treated with Berlin-Frankfurt-Munster protocols (June 2013 - December 2016).
- Evaluation of 446 febrile neutropenic episodes in 85 children, assessing antifungal treatment administration.
Main Results:
- Antifungal therapy frequency increased significantly with leukemia risk (standard < intermediate < high < relapsed).
- Intermediate-risk (IR) patients required more antifungal therapy during induction compared to other phases.
- High-risk (HR) patients needed antifungal therapy more throughout induction and HR consolidation phases.
Conclusions:
- Antifungal therapy requirements correlate with chemotherapy severity and intensity across all risk groups.
- IR patients' induction antifungal needs mirrored HR patients' induction and consolidation needs.
- Further research is recommended to explore primary antifungal prophylaxis benefits for IR patients.
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