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Updated: Jun 27, 2025
Live Imaging of Antifungal Activity by Human Primary Neutrophils and Monocytes in Response to A. fumigatus
Published on: April 19, 2017
Primary Mold-Active Antifungal Prophylaxis Decreases the Need for Chest Computed Tomography Scans in Patients with
Nihal Karadaş1, Hamiyet Hekimci Özdemir1, Yeşer Yilmaz2
1Ege University Faculty of Medicine, Children's Hospital, Department of Pediatric Hematology, IZMIR, Bornova, Turkey.
Abstract:
Current guidelines recommend computed tomography (cCT) scans of the chest in children with leukemia following 96 h of the onset of idiopathic neutropenia to eliminate pulmonary invasive fungal infections (IFIs). However, cCT exposes some children who are at a very high risk of developing secondary cancers to radiation. We aimed to determine the effect of antifungal prophylaxis (AFP) with voriconazole (VCZ) on the need for cCT scans in children with acute lymphoblastic leukemia (ALL) to eliminate pulmonary IFIs during chemotherapy. We retrospectively screened all patients' data from their electronic charts. Children who were diagnosed as having ALL before February 2013 and did (AFP group) or did not (NoP group) receive AFP were divided into two groups and compared regarding cCT scans and relapse-mortality rates. Ninety-six children were diagnosed before February 2013 and did not receive primary AFP and 146 children were administered VCZ following a diagnosis of ALL. There were no significant demographic differences between the groups. A total of 128 cCTs had been required in 62 children in the NoP group, compared with 64 cCTs in 52 children in the AFP group. The percentage of the patients who had required at least one chest CT scan and the mean number of cCT scans in the NoP group were significantly higher compared with the AFP group. Proven-probable IFIs and relapse-mortality rates were higher in the NoP group compared with the AFP group. Mold-active AFP revealed a significant decrease in the need for cCT scans in children with ALL.
Insights
Antifungal prophylaxis (AFP) with voriconazole significantly reduced the need for computed tomography (cCT) chest scans in children with acute lymphoblastic leukemia (ALL). This approach also lowered rates of invasive fungal infections and mortality.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Radiology
Background:
- Current guidelines recommend chest computed tomography (cCT) scans for children with leukemia to detect invasive fungal infections (IFIs).
- cCT scans expose high-risk pediatric patients to radiation, increasing the risk of secondary cancers.
Purpose of the Study:
- To evaluate the impact of antifungal prophylaxis (AFP) with voriconazole (VCZ) on the necessity of cCT scans in children with acute lymphoblastic leukemia (ALL).
- To assess if AFP can mitigate the need for radiation exposure from cCT scans in this vulnerable population.
Main Methods:
- Retrospective analysis of electronic health records for children diagnosed with ALL before February 2013.
- Comparison of two groups: those who received mold-active AFP (voriconazole) versus those who did not (NoP group).
- Evaluation of cCT scan utilization, proven-probable IFIs, and relapse-mortality rates between the groups.
Main Results:
- The AFP group required significantly fewer cCT scans (64 scans in 52 children) compared to the NoP group (128 scans in 62 children).
- A lower percentage of patients in the AFP group needed at least one cCT scan.
- The NoP group exhibited higher rates of proven-probable IFIs and relapse-mortality compared to the AFP group.
Conclusions:
- Mold-active antifungal prophylaxis, specifically with voriconazole, significantly decreases the requirement for chest cCT scans in children undergoing chemotherapy for ALL.
- AFP serves as an effective strategy to reduce radiation exposure in pediatric ALL patients while managing IFI risk.
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