Invasive fungal disease in children with acute myeloid leukaemia: An Australian multicentre 10‐year review. Issue 11 (6th August 2021)

• Record Type: Journal Article
• Authors: Yeoh, Daniel K.; Moore, Andrew S.; Kotecha, Rishi S.; Bartlett, Adam W.; Ryan, Anne L.; Cann, Megan P.; McMullan, Brendan J.; Thursky, Karin; Slavin, Monica; Blyth, Christopher C.; Haeusler, Gabrielle M.; Clark, Julia E.
• Is Part Of: Pediatric blood & cancer. Volume 68:Issue 11(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-08-06
• Subjects: acute myeloid leukaemia -- antifungal -- children -- invasive fungal disease -- prevalence -- prophylaxis; Tumors in children -- Periodicals; Blood -- Diseases -- Periodicals; Cancer in children -- Periodicals; 618.92
• DOI: 10.1002/pbc.29275
• Languages: English
• ISSNs: 1545-5009

Abstract

Abstract: Background: Invasive fungal disease (IFD) is a common and important complication in children with acute myeloid leukaemia (AML). We describe the epidemiology of IFD in a large multicentre cohort of children with AML. Methods: As part of the retrospective multicentre cohort TERIFIC (The Epidemiology and Risk factors for Invasive Fungal Infections in immunocompromised Children) study, proven/probable/possible IFD episodes occurring in children with primary or relapsed/refractory AML from 2003 to 2014 were analysed. Crude IFD prevalence, clinical characteristics, microbiology and treatment were assessed. Kaplan–Meier survival analysis was used to estimate 6‐month survival. Results: There were 66 IFD episodes diagnosed in 63 children with AML. The majority (75.8%) of episodes occurred in the context of primary AML therapy. During primary AML therapy, the overall prevalence was 20.7% (95% CI 15.7%–26.5%) for proven/probable/possible IFD and 10.3% (95% CI 6.7%–15.0%) for proven/probable IFD. Of primary AML patients, 8.2% had IFD diagnosed during the first cycle of chemotherapy. Amongst pathogens implicated in proven/probable IFD episodes, 74.4% were moulds, over a third (37.9%) of which were non‐ Aspergillus spp. Antifungal prophylaxis preceded 89.4% of IFD episodes, most commonly using fluconazole (50% of IFD episodes). All‐cause mortality at 6 months from IFD diagnosis was 16.7% with IFD‐related mortality of 7.6% (all in cases of proven IFD). Conclusions: IFD is a common and serious complication during paediatric AML therapy. Mould infections, including non‐ Aspergillus spp. predominated in this cohort. A systematic approach to the identification of patients at risk, and a targeted prevention strategy for IFD is needed.