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Breakthrough Invasive Fungal Infections in Pediatric Acute Myeloid and Lymphoblastic Leukemia Receiving Mold-active
Belgin Gülhan1, Fatma Ünal2, Özlem Arman3
1From the Pediatric Infectious Disease Department, Ankara Bilkent Children City Hospital, University of Health Science.
The Pediatric Infectious Disease Journal
|March 3, 2026
Summary
Despite antifungal prophylaxis, nearly one-third of pediatric leukemia patients developed invasive fungal infections (IFIs). High mortality rates in probable and proven IFIs highlight limitations in current strategies for these vulnerable children.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- Oncology
Background:
- Breakthrough invasive fungal infections (IFIs) are a significant challenge in pediatric acute leukemia patients, even with antifungal prophylaxis.
- Limited data exists on the epidemiology, risk factors, and outcomes of IFIs in this population.
Purpose of the Study:
- To investigate the incidence, characteristics, and outcomes of breakthrough IFIs in children with acute leukemia receiving mold-active antifungal prophylaxis.
- To evaluate the effectiveness of current prophylactic strategies and identify areas for improvement.
Main Methods:
- Retrospective cohort study of 147 pediatric acute leukemia patients (0-18 years) treated between February 2019 and December 2023.
- Analysis of demographic and clinical features, antifungal prophylaxis regimens, IFI classification (EORTC/MSGERC 2020 criteria), microbiological and radiological findings, and outcomes.
- Patients received mold-active antifungal prophylaxis, primarily voriconazole.
Main Results:
- Overall, 29.3% of patients developed IFIs, with similar incidence in acute lymphoblastic leukemia (29.0%) and acute myeloid leukemia (31.2%).
- Most IFIs were classified as possible (81.4%), with lower proportions of probable (11.6%) and proven (7.0%) cases.
- A case-fatality rate of 16.3% (7/43) was observed among patients with IFIs, with significantly higher mortality in probable (60.0%) and proven (66.7%) infections compared to possible infections (5.7%).
Conclusions:
- Nearly one-third of pediatric leukemia patients developed IFIs despite mold-active prophylaxis, indicating limitations in current prophylactic strategies.
- High mortality associated with probable and proven IFIs necessitates improved diagnostic approaches and optimized prophylactic regimens.
- Further research is needed to enhance therapeutic drug monitoring and early diagnostic methods to reduce IFI burden in high-risk pediatric leukemia patients.
Keywords:
antifungal prophylaxisbreakthrough infectionsinvasive fungal infectionsneutropeniapediatric leukemiaMore Related Videos
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