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Invasive Fungal Infections in Children with Leukemia: Clinical Features and Prognosis
Melike Sezgin Evim1, Özlem Tüfekçi2, Birol Baytan1
1Uludağ University Faculty of Medicine, Department of Pediatric Hematology, Bursa, Turkey
Objective:
The incidence of invasive fungal infections (IFIs) has increased due to intensive chemotherapy in childhood leukemia. The aim of this study was to evaluate the incidence, risk factors, causative pathogens, and impact on survival of IFIs among pediatric leukemia patients.
Materials And Methods:
The hospital records of 307 children with acute lymphoblastic leukemia (ALL, n=238), acute myeloid leukemia (AML, n=51), and relapsed leukemia (n=18) between January 2010 and December 2015 were retrospectively evaluated.
Results:
A total of 1213 febrile neutropenia episodes were recorded and 127 (10.4%) of them were related to an IFI. Of 307 children, 121 (39.4%) developed IFIs. The mean age was significantly older in the IFI group compared to children without IFIs (p<0.001). IFIs were defined as possible, probable, and proven in 73.2%, 11.9%, and 14.9% of the attacks, respectively. Invasive aspergillosis (81.9%) was the most frequent infection, followed by invasive candidiasis (13.4%) and rare fungal diseases (4.8%). The majority of IFI attacks in both ALL and AML occurred during the induction phase. In total, the death rate was 24% and the IFI-related mortality rate was 18%. The mortality rate among children with IFIs was found to be significantly higher than that of children without IFIs (p<0.001). Overall and event-free survival rates at 5 years were also found to be significantly lower in the IFI group (p<0.001). Relapse (odds ratio: 8.49) was the most effective risk factor for mortality, followed by developing an IFI episode (odds ratio: 3.2) and AML (odds ratio: 2.33) according to multivariate regression analysis.
Conclusion:
Our data showed that IFIs were more common in older children. Although proven and probable IFI episodes were more frequently diagnosed in cases of relapse and AML, children with ALL and AML had similar frequencies of experiencing at least one episode Conclusion: Our data showed that IFIs were more common in older children. Although proven and probable IFI episodes were more frequently diagnosed in cases of relapse and AML, children with ALL and AML had similar frequencies of experiencing at least one episode
Insights
Invasive fungal infections (IFIs) significantly increase mortality in pediatric leukemia patients, particularly older children and those with acute myeloid leukemia (AML). Relapse and IFIs are key risk factors for death, impacting survival rates.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Intensive chemotherapy for childhood leukemia has led to a rise in invasive fungal infections (IFIs).
- Understanding the epidemiology and impact of IFIs in this vulnerable population is crucial.
Purpose of the Study:
- To evaluate the incidence, risk factors, causative pathogens, and survival impact of IFIs in pediatric leukemia patients.
- To identify key factors contributing to mortality in children with leukemia and IFIs.
Main Methods:
- Retrospective analysis of hospital records for 307 children with leukemia (ALL, AML, relapsed) from 2010-2015.
- Evaluation of febrile neutropenia episodes, IFI diagnosis, and patient outcomes, including survival and mortality.
Main Results:
- 121 (39.4%) of 307 children developed IFIs, more common in older children.
- Invasive aspergillosis was the most frequent IFI (81.9%), followed by candidiasis (13.4%).
- IFIs were associated with significantly higher mortality (18% IFI-related) and lower survival rates (p<0.001). Relapse, IFIs, and AML were significant mortality risk factors.
Conclusions:
- Invasive fungal infections are a significant concern in pediatric leukemia, particularly in older children.
- IFIs are linked to increased mortality and reduced survival, with relapse and specific leukemia types being critical risk factors.
- Early diagnosis and management of IFIs are essential for improving outcomes in pediatric leukemia patients.
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