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Mucormycosis in children with haematological malignancies is a salvageable disease: a report from the Israeli Study Group of Childhood Leukemia
Author(s) -
Elitzur Sarah,
AradCohen Nira,
Barg Assaf,
Litichever Naomi,
Bielorai Bella,
Elhasid Ronit,
Fischer Salvador,
Fruchtman Yariv,
Gilad Gil,
Kapelushnik Joseph,
Kharit Mira,
Konen Osnat,
Laor Ruth,
Levy Itzhak,
Raviv Dror,
ShachorMeyouhas Yael,
ShvartserBeryozkin Yulia,
Toren Amos,
Yaniv Isaac,
Nirel Ronit,
Izraeli Shai,
BarzilaiBirenboim Shlomit
Publication year - 2020
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.16329
Subject(s) - mucormycosis , medicine , incidence (geometry) , malignancy , retrospective cohort study , pediatrics , cumulative incidence , cohort , population , hematologic malignancy , acute leukemia , standardized mortality ratio , leukemia , surgery , physics , environmental health , optics
Summary Mucormycosis has emerged as an increasingly important cause of morbidity and mortality in immunocompromised patients, but contemporary data in children are lacking. We conducted a nationwide multicentre study to investigate the characteristics of mucormycosis in children with haematological malignancies. The cohort included 39 children with mucormycosis: 25 of 1136 children (incidence 2·2%) with acute leukaemias prospectively enrolled in a centralized clinical registry in 2004–2017, and an additional 14 children with haematological malignancies identified by retrospective search of the databases of seven paediatric haematology centres. Ninety‐two percent of mucormycosis cases occurred in patients with acute leukaemias. Mucormycosis was significantly associated with high‐risk acute lymphoblastic leukaemia (OR 3·75; 95% CI 1·51–9·37; P = 0·004) and with increasing age (OR 3·58; 95% CI 1·24–9·77; P = 0·01). Fifteen patients (38%) died of mucormycosis. Rhinocerebral pattern was independently associated with improved 12‐week survival (OR 9·43; 95% CI 1·47–60·66; P = 0·02) and relapsed underlying malignancy was associated with increased 12‐week mortality (OR 6·42; 95% CI, 1·01–40·94; P = 0·05). In patients receiving frontline therapy for their malignancy ( n = 24), one‐year cumulative mucormycosis‐related mortality was 21 ± 8% and five‐year overall survival was 70 ± 8%. This largest paediatric population‐based study of mucormycosis demonstrates that children receiving frontline therapy for their haematological malignancy are often salvageable.