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Invasive fungal disease in children with acute myeloid leukaemia: An Australian multicentre 10‐year review
Author(s) -
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.
Publication year - 2021
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.29275
Subject(s) - medicine , cohort , epidemiology , context (archaeology) , pediatrics , retrospective cohort study , disease registry , disease , biology , paleontology
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.