Invasive Fungal Infections in Children with Acute Leukemia: Epidemiology, Risk Factors, and Outcome

Area of Science:

• Pediatric Oncology
• Infectious Diseases
• Hematology

Background:

• Invasive fungal infections (IFI) pose a serious threat, causing significant morbidity and mortality in pediatric patients with acute leukemia (AL).
• Febrile neutropenic episodes (FNE) are common during AL treatment and represent a critical period for IFI development.
• Understanding risk factors and IFI patterns in different AL risk categories is crucial for effective management.

Purpose of the Study:

• To retrospectively analyze the incidence and associated factors of proven or probable IFI in children with AL.
• To differentiate IFI risks between high-risk for IFI (HR-IFI-AL) and non-high-risk for IFI (non-HR-IFI-AL) pediatric leukemia patients.
• To identify clinical factors associated with IFI development and outcomes in this vulnerable population.

Main Methods:

• Retrospective data collection on febrile neutropenic episodes (FNE) in children with AL between 2016 and 2021.
• Categorization of patients into HR-IFI-AL (high-risk ALL, AML, relapse) and non-HR-IFI-AL (standard/intermediate risk ALL) groups.
• Multivariable analysis to identify factors associated with proven/probable IFI and assess outcomes.

Main Results:

• Out of 93 children and 339 FNE, 17 children (18.3%) developed 19 proven/probable IFI (11 yeast, 8 molds).
• HR-IFI-AL children had higher rates of proven/probable mold IFI (13.5%) and associated mortality (15.4%), while non-HR-IFI-AL patients had a higher risk of invasive candidiasis (yeast IFI).
• Underlying genetic syndrome, oral mucositis, and older age were significant risk factors for IFI; longer time since AL diagnosis was protective.

Conclusions:

• Pediatric acute leukemia patients, particularly those in the HR-IFI-AL category, face distinct IFI risks (molds vs. yeast), underscoring the need for risk stratification.
• Close monitoring of local IFI epidemiology and tailored clinical practices are essential for improving outcomes in children with AL.
• The study highlights the critical impact of IFI on mortality in HR-IFI-AL children and the prevalence of invasive candidiasis in other risk groups.