Impact of Invasive Fungal Diseases on Treatment Outcomes in Pediatric Acute Lymphoblastic Leukemia and Lymphoblastic...

Invasive fungal diseases (IFD) in children with newly diagnosed acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) are poorly characterized, especially in lower-middle-income countries (LMICs). This study aims to identify the incidence, risk factors, and outcomes of IFD in a pediatric cohort with ALL/LBL.

We retrospectively analyzed pediatric patients diagnosed with ALL/LBL between January and December 2023 at a tertiary cancer center in India. Patients were risk-stratified and treated per the modified ICiCLe-ALL-14 protocol. IFDs were classified as proven, probable, and possible according to the revised EORTC/MSG consensus definition.

Among 407 patients, 392(96%) had ALL. The overall incidence of IFD was 25%, with probable/proven infections in 12%. Mold infections predominated (79 cases, 77%), followed by yeast infections (21 cases, 21%). In comparison with patients without IFDs, those with IFDs were more likely to have received dexamethasone (30 vs. 20%; p = 0.009), anthracycline (28 vs. 14%; p = 0.001) during induction and have central venous access (27 vs. 18%; p = 0.008). The 6-week mortality rate of patients with IFD was 15%, rising to 26% in probable/proven cases. Coexisting bacterial infection was associated with increased mortality (odds ratio: 19.2[95%CI: 3.5-105]; p = 0.001).

IFDs are common in newly diagnosed ALL/LBL patients in LMICs, particularly during early phases of therapy. These infections are associated with considerable mortality, often compounded by concomitant bacterial sepsis. Given these findings, consideration of antifungal prophylaxis is warranted to mitigate morbidity and mortality due to IFDs.