Fungal prophylaxis and prevalence of fungal infections in children with cancer

Abstract

Purpose

Children with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), and allogeneic haemopoietic stem cell transplantation (HSCT) are at high risk of invasive fungal infection (IFI), which contributes to morbidity and mortality. The purpose of this study was to describe fungal prophylaxis and IFI for children at our hospital.

Methods

The primary objective was to describe fungal prophylaxis for children with AML, relapsed ALL, and HSCT. Secondary objectives included describing prevalence of proven, probable, or possible fungal infections; type of fungal infection; and prevalence and type of adverse effects of fungal prophylaxis. This was a retrospective cohort study of children admitted to our hospital with AML, relapsed ALL, and HSCT between January 2015 and June 2019.

Results

We included 105 patients with 263 inpatient visits. Eighty-three patients (79%) had fungal prophylaxis at all visits. Fungal prophylaxis was present at 91 (95%) inpatient visits for AML, 15 (21%) for relapsed ALL, and 87 (99%) for HSCT. Caspofungin was the most prescribed antifungal (86%). There were 4 patients each with proven and possible IFI and 11 patients with probable IFI, representing a prevalence of 18.1%. There were 10 patients with fungal infection in the lungs, 2 patients each in the liver and spleen, and 1 patient with disseminated fungal infection. There was a total of 283 adverse events in 79 (40.1%) patients.

Conclusion

The prevalence of IFI in this population is within range of what is reported from other countries. Choice of fungal prophylaxis was consistent with published guideline recommendations.