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Invasive Fungal Infection in Patients With Initial Treatment of Pediatric Acute Lymphoblastic Leukemia: A
Ryoji Kobayashi1, Daiki Hori, Hirozumi Sano
1Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Sapporo, Japan.
Abstract:
The prognosis for pediatric hematological malignancies has improved greatly, but infectious diseases, especially invasive fungal infection (IFI), are an important complication that may make it difficult to continue treatment. In this study, IFIs in the treatment of the initial diagnosis of acute lymphoblastic leukemia (ALL), excluding relapse and transplantation, were investigated retrospectively. The patients were 152 first-diagnosed ALL cases (85 males and 67 females) admitted to our hospital between April 2007 and December 2024. The median age of these patients was 6.8 years. The median leukocyte count was 10.2×10 9 /L and the cell surface markers of the blasts were B precursor in 124 cases, T in 20 cases, mature B in 3 cases, and mixed lineage in 5 cases. The diagnosis of IFI was based on EORTC/MSG diagnostic criteria. Sixteen of the 152 patients (10.5%) were found to have IFIs; one was "proven," 7 were "probable," and 8 were "possible." The median time of IFI onset from the start of ALL treatment was 41 days (-7 to 258 d), with 56.3% of cases occurring at first onset of ALL or during induction therapy. Although 4 of 16 patients with IFIs died, IFI was the direct cause of death in 2 cases. Age 7.5 years or older was the only risk factor for IFI.
Insights
Invasive fungal infections (IFIs) complicate treatment for pediatric acute lymphoblastic leukemia (ALL). Older age (≥7.5 years) is a significant risk factor for developing IFIs during initial ALL treatment.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Pediatric hematological malignancies have improved prognoses, but infectious complications remain a challenge.
- Invasive fungal infections (IFIs) are a significant concern, potentially disrupting treatment for acute lymphoblastic leukemia (ALL).
Purpose of the Study:
- To investigate the incidence and characteristics of IFIs in children with newly diagnosed ALL.
- To identify risk factors associated with IFIs in this patient population.
Main Methods:
- Retrospective analysis of 152 pediatric patients with first-diagnosed ALL.
- IFIs diagnosed based on EORTC/MSG criteria.
- Data collected on patient demographics, leukemia characteristics, and IFI occurrence.
Main Results:
- 10.5% (16/152) of patients developed IFIs.
- The median time to IFI onset was 41 days from the start of ALL treatment.
- Age 7.5 years or older was identified as the sole significant risk factor for IFI.
- 4 out of 16 patients with IFIs died, with IFI being the direct cause in 2 cases.
Conclusions:
- IFIs are a notable complication in pediatric ALL, particularly during initial treatment phases.
- Early identification of risk factors, such as older age, is crucial for timely intervention.
- Managing IFIs is essential for improving treatment continuity and outcomes in pediatric ALL.
