Retrospective study on the incidence and outcome of proven and probable invasive fungal infections in high-risk pediatric onco-hematological patients

Background invasive fungal infection (IFI) is a cause of morbidity, mortality and increased health costs in children undergoing chemotherapy or hematopoietic stem cell transplant (HSCT). Methods multi-center, retrospective study to assess the incidence, outcome of proven and probable IFI (PP-IFI) in children treated for acute leukemia, non-Hodgkin lymphoma or who underwent HSCT from 2006 to 2012. Results Over the 7-year period, 127 PP-IFI were diagnosed in 123 patients, median age of 9.7 years. The 1-year cumulative incidence was 2.5% (CI, 1.8-3.7) after front-line chemotherapy, 9.4% (CI, 5.8-15.0) after relapse, and 5.3% (CI, 3.9-7.1) after HSCT. Severe neutropenia was present in 98 (77%) patients. Culture-proven agents were: Candida spp., mostly non-albicans, 28, mould 23, whereas 3 proven IFI were identified by histopatholoy. Favorable response to treatment within 3 months from diagnosis was observed in 77 (89%). The overall ninety-day probability of survival was 68% (C.I. 59-76). Conclusions about two-thirds of pediatric patients with PP-IFI survived, regardless of whether the infection occurred after front-line chemotherapy, reinduction chemotherapy for disease relapse, or after HSCT. Further prospective studies are needed to define the impact of antifungal prophylaxis and early combination therapy on short-term overall survival. This article is protected by copyright. All rights reserved.