Incidence, Risk Factors and Prophylaxis use Concerning Invasive Fungal Infections in Children with Newly Diagnosed Acute Lymphoblastic Leukemia.

Abstract

Background. With achievable acute lymphoblastic leukemia (ALL) survival rates of 80-90%, non-leukemic events lead to a high proportion of treatment failure. An important cause of morbidity and mortality related to intensified chemotherapy is infection. Procedure. In this study, the incidence, severity and related pathogen of severe invasive fungal infections (IFI) in the induction and intensification phase reported during the Dutch Childhood Oncology Group (DCOG) ALL-10 protocol were evaluated. IFI grade 3 /4 and grade 5 (death) were reported. Also risk factors for IFI were studied. Additionally, the antifungal policy of all Dutch pediatric oncology centers according to two Dutch national protocols were compared. Results. Out of 776 patients, 38 cases (5%) of severe IFI were revealed. 35/38 cases (92%) occurred during the induction phase. 33/38 cases (87%) were graded as severe IFI (grade 3 /4), and the others as grade 5. The pathogen was significantly related to the severity of IFI (p = 0.024). In 19 cases (50%) IFI was caused by candida; none of these were fatal. 17/38 (45%) patients had an IFI caused by aspergillus of which 4 were fatal. Regarding all IFI, younger median age (OR, 1.5; CI 0.037;0.834) and Down syndrome (OR, 4.7; CI 1.880;11.545) were risk factors for development of IFI. Conclusions. Administration of an antifungal agent should be (re)considered during the induction phase. This agent should especially be effective against aspergillus. Younger median age and Down syndrome as risk factor for IFI should be confirmed by other studies.