Invasive fungal disease in children with acute myeloid leukaemia: An Australian multicentre 10-year review

Daniel K. Yeoh, Andrew S. Moore, Rishi S. Kotecha, Adam W. Bartlett, Anne L. Ryan, Megan P. Cann, Brendan J. McMullan, Karin Thursky, Monica Slavin, Christopher C. Blyth, Gabrielle M. Haeusler, Julia E. Clark

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1 Citation (Scopus)

Abstract

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.

Original languageEnglish
Article numbere29275
Pages (from-to)e29275
JournalPEDIATRIC BLOOD & CANCER
Volume68
Issue number11
DOIs
Publication statusPublished - Nov 2021

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