Related Experiment Video
Updated: Mar 4, 2026
An Ex vivo Assay to Study Candida albicans Hyphal Morphogenesis in the Gastrointestinal Tract
Published on: July 1, 2020
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.
Background:
Breakthrough invasive fungal infections (IFIs) remain a major challenge in children with acute leukemia, even under mold-active prophylaxis. Data on the epidemiology, risk factors and outcomes of breakthrough IFIs in pediatric populations are limited.
Methods:
This study included patients 0-18 years of age with acute leukemia who were diagnosed and followed at the Pediatric Hematology Clinic of Ankara Bilkent City Hospital between February 2019 and December 2023. We conducted a retrospective cohort study of 147 pediatric patients with acute leukemia who received mold-active antifungal prophylaxis. Demographic and clinical features, antifungal prophylactic regimens, infection classifications (proven, probable and possible), microbiological and radiological findings and outcomes were analyzed. IFIs were defined and classified according to the EORTC/MSGERC 2020 criteria.
Results:
Among 147 patients (43.5% female, 56.5% male; mean age 9.5 years), 68.0% had acute lymphoblastic leukemia and 32.0% had acute myeloid leukemia. All patients received mold-active prophylaxis, most commonly voriconazole (84.4%, n = 124). Overall, 29.3% (n = 43) of patients developed an IFI. Among those with IFI, 81.4% (n = 35) were classified as possible, 11.6% (n = 5) as probable and 7.0% (n = 3) as proven. Infection incidence was similar between acute lymphoblastic leukemia (29.0%) and acute myeloid leukemia (31.2%) ( P = 0.779). A total of 7 patients died because of the fungal infections, yielding a case-fatality rate of 16.3% (7/43) among patients with IFI. Mortality varied markedly by diagnostic certainty: 5.7% in possible, 60.0% in probable and 66.7% in proven IFIs. Proven/probable infections were mainly due to Aspergillus spp. The most frequently used therapeutic agents were liposomal amphotericin B (43.2%) and caspofungin (30.9%), alone or in combination.
Conclusion:
Despite mold-active antifungal prophylaxis, nearly one-third of pediatric leukemia patients developed IFIs, with high mortality in probable and proven cases. The predominance of breakthrough mold infections underscores the limitations of current prophylactic strategies. Optimized prophylaxis, therapeutic drug monitoring and early diagnostic approaches are urgently needed to reduce the burden of IFIs in this high-risk population.
Insights
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.
More Related Videos
Related Concept Videos
01:29Fungal Group Zygomycota
01:28Fungal Phylum Microsporidia