Stacie S Wang1, Rishi S Kotecha2,3,4, Anne Bernard5, Christopher C Blyth6,7,8, Brendan J McMullan9,10,11, Megan P Cann12, Daniel K Yeoh7, Adam W Bartlett10,11,13, Anne L Ryan2, Andrew S Moore14,15, Penelope A Bryant16,17,18, Julia Clark12,19,20, Gabrielle M Haeusler9,16,17,21,22,23. 1. Children's Cancer Centre, Royal Children's Hospital, Melbourne, Victoria, Australia. 2. Department of Haematology and Oncology, Perth Children's Hospital, Perth, Western Australia, Australia. 3. Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia. 4. School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Western Australia, Australia. 5. QFAB Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia. 6. School of Medicine and Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia. 7. Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia. 8. Department of Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia. 9. NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia. 10. Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia. 11. School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia. 12. Infection Management Service, Queensland Children's Hospital, Brisbane, Queensland, Australia. 13. Biostatistics and Databases Program, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia. 14. Oncology Services Group, Queensland Children's Hospital, Brisbane, Queensland, Australia. 15. Diamantina Institute & Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia. 16. Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia. 17. Clinical Paediatrics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia. 18. Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia. 19. School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia. 20. Centre for Children's Health Research, Children's Health Queensland, Brisbane, Queensland, Australia. 21. The Paediatric Integrated Cancer Service, Melbourne, Victoria, Australia. 22. Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia. 23. Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: Invasive fungal infections (IFI) are an important complication of acute lymphoblastic leukaemia (ALL) treatment. Our study describes the prevalence and outcomes of IFI in children with ALL. METHODS: IFI episodes in children with primary or relapsed ALL, identified for The Epidemiology and Risk Factors for Invasive Fungal Infections in Immunocompromised Children study, were analysed. IFI were classified according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group criteria with a 'modified-possible' category included. RESULTS: A total of 123 IFI episodes in 119 patients with ALL were included. A proven, probable, possible and modified-possible IFI was diagnosed in 56 (45.5%), 22 (17.9%), 39 (31.7%) and six (4.9%) episodes, respectively. The prevalence was 9.7% (95% confidence interval [CI] 8-11.4%) overall and 23.5% (95% CI 14.5-32.5%) for relapsed/refractory ALL. For non-relapsed ALL, the IFI prevalence was significantly higher for children with high-risk compared to standard-risk ALL (14.5% vs 7.3%, P = .009), and IFI were more common during induction, consolidation and delayed intensification phases. Mould infections occurred more frequently than non-mould infections. Thirteen children (10.9%) died within 6 months of IFI diagnosis with five deaths (4.2%) attributable to an IFI. CONCLUSIONS: IFI is more common in children with high-risk ALL and in relapsed disease. Overall survival was encouraging, with IFI contributing to very few deaths.
BACKGROUND:Invasive fungal infections (IFI) are an important complication of acute lymphoblastic leukaemia (ALL) treatment. Our study describes the prevalence and outcomes of IFI in children with ALL. METHODS: IFI episodes in children with primary or relapsed ALL, identified for The Epidemiology and Risk Factors for Invasive Fungal Infections in Immunocompromised Children study, were analysed. IFI were classified according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group criteria with a 'modified-possible' category included. RESULTS: A total of 123 IFI episodes in 119 patients with ALL were included. A proven, probable, possible and modified-possible IFI was diagnosed in 56 (45.5%), 22 (17.9%), 39 (31.7%) and six (4.9%) episodes, respectively. The prevalence was 9.7% (95% confidence interval [CI] 8-11.4%) overall and 23.5% (95% CI 14.5-32.5%) for relapsed/refractory ALL. For non-relapsed ALL, the IFI prevalence was significantly higher for children with high-risk compared to standard-risk ALL (14.5% vs 7.3%, P = .009), and IFI were more common during induction, consolidation and delayed intensification phases. Mould infections occurred more frequently than non-mould infections. Thirteen children (10.9%) died within 6 months of IFI diagnosis with five deaths (4.2%) attributable to an IFI. CONCLUSIONS: IFI is more common in children with high-risk ALL and in relapsed disease. Overall survival was encouraging, with IFI contributing to very few deaths.
Authors: Vera Bain; Anna Carlota Mott Galvão de Arruda Barrientos; Lisa Suzuki; Luiz Antonio Nunes de Oliveira; Nadia Litvinov; Karina Rodrigues Peron; Juliana Folloni Fernandes; Heloisa Helena de Sousa Marques Journal: Radiol Bras Date: 2022 Mar-Apr