TY  - JOUR
TI  - Invasive Fungal Infections in Children with Leukemia: Clinical
Features and Prognosis
AB  - Objective: The incidence of invasive fungal infections (IFIs) has
increased due to intensive chemotherapy in childhood leukemia. The
aim of this study was to evaluate the incidence, risk factors, causative
pathogens, and impact on survival of IFIs among pediatric leukemia
patients.
Materials and Methods: The hospital records of 307 children with
acute lymphoblastic leukemia (ALL, n=238), acute myeloid leukemia
(AML, n=51), and relapsed leukemia (n=18) between January 2010 and
December 2015 were retrospectively evaluated.
Results: A total of 1213 febrile neutropenia episodes were recorded
and 127 (10.4%) of them were related to an IFI. Of 307 children, 121
(39.4%) developed IFIs. The mean age was significantly older in the IFI
group compared to children without IFIs (p<0.001). IFIs were defined
as possible, probable, and proven in 73.2%, 11.9%, and 14.9% of
the attacks, respectively. Invasive aspergillosis (81.9%) was the most
frequent infection, followed by invasive candidiasis (13.4%) and rare
fungal diseases (4.8%). The majority of IFI attacks in both ALL and
AML occurred during the induction phase. In total, the death rate was
24% and the IFI-related mortality rate was 18%. The mortality rate
among children with IFIs was found to be significantly higher than
that of children without IFIs (p<0.001). Overall and event-free survival
rates at 5 years were also found to be significantly lower in the IFI
group (p<0.001). Relapse (odds ratio: 8.49) was the most effective risk
factor for mortality, followed by developing an IFI episode (odds ratio:
3.2) and AML (odds ratio: 2.33) according to multivariate regression
analysis.
Conclusion: Our data showed that IFIs were more common in older
children. Although proven and probable IFI episodes were more
frequently diagnosed in cases of relapse and AML, children with ALL
and AML had similar frequencies of experiencing at least one episode of IFI. Rare fungal diseases were also identified as a major problem.
Despite success in treatment, IFIs increased the rate of mortality in
children with acute leukemia.
AU  - meral gunes, adalet
AU  - ELMAS, KEVSER USTUN
AU  - sezgin evim, melike
AU  - ERDEM, MELEK
AU  - Ören, Hale
AU  - YILMAZ, Şebnem
AU  - Tüfekçi, Özlem
AU  - Celebi, Solmaz
AU  - Ener, Beyza
AU  - Baytan, Birol
AU  - HACIMUSTAFAOĞLU, Mustafa Kemal
DO  - 10.4274/tjh.galenos.2021.2021.0203
PY  - 2022
JO  - Turkish Journal of Hematology
VL  - 39
IS  - 2
SN  - 1300-7777
SP  - 94
EP  - 102
DB  - TRDizin
UR  - http://search/yayin/detay/515103
ER  -