Probable/proven invasive aspergillosis in children with malignancy registered in database FIND, Study on behalf of the Czech Leukemia Study Group for life CELL

Ref ID: 19423

Author:

P. Sedlacek,1 V. Chrenkova,2 P. Mudry,3 J. Horakova,4 J. Muzik,5
Y. Jabali,6 N. Mallatova,7 P. Hubacek,2 I. Kocmanova,8
B. Weinbergerova8 and Z. Racil9

Author address:

1University Hospital Motol, Prague, Czech Republic; 2Department
of Medical Microbiology, University Hospital Motol, Prague,
Czech Republic; 3Department of Pediatric Oncology, University
Hospital Brno, Czech Republic; 4Department of Pediatric
Hema

Full conference title:

6th Trends in Medical Mycology 2013

Date: 11 October 2014

Abstract:

Objectives Despite increasing spectrum of diagnostic tools and avail-
able antifungals invasive aspergillosis (IA) still remains serious life-
threatening complication of intensive chemotherapy in children with
malignancy. Here we present analysis of retrospectively obtained
data in database FIND about diagnosis, therapy and outcome of chil-
dren diagnosed with probable or proven IA.
Methods 32 children in the median age of 10 years (range 2-17) from
four pediatric hemato/oncological centers with proven (12; 37.5%) or
probable (20; 62.5%) IA were registered between 2002 and 2012.
Underlying disease in 21 patients was acute leukemia (lymphoblastic in
18; 56%), 5 patients suffered from solid tumor and 6 from other hema-
tological malignancy (MDS, NHL). 6 patients previously underwent
allogeneic and 2 autologous stem cell transplantation. Diagnosis of pro-
ven/probable IA was defined according to EORTC/MSG criteria.
Results Pulmonary IA was the most frequent form (23; 72%) fol-
lowed by disseminated form (4) or other (5). Among major risk fac-
tors for IA were: malignancy (100%), stem cell transplantation or
other chemotherapy (100%), neutropenia (<0.5 x 10.9/l > 10 days)
in 19 patients (59%), steroid therapy (>21 days) in 19 patients
(59%) and graft versus host disease in 6 patients. Galactomannan
was positive in blood in 8/27 (30%) and in BAL in 8/9 (89%) of
patients tested. Cultures were positive for Aspergillus in 6/12 of
patients with proven and 13/20 with probable IA with predomi-
nance of A. fumigatus (14/19; 74%) followed by A. niger (2), A. terreus
(1) or other (3). Median time to diagnosis of IA from start of
empirical therapy was 8 days. Empirical antifungal therapy (26/32;
81%) consisted of amphotericin B formulations in 43%, echinocan-
dins in 23% and voriconazole in 15%. Targeted therapy was initiated
in 30/32 patients (94%) and consisted of amphotericin B formula-
tions (10 pts), voriconazole (5 pts), echinocandins (2 pts), echinocan-
dins with voriconazole (5 pts) or other (8 pts). After 1st line therapy
out of 30 treated patients 10 (33%) achieved complete/partial
response,13 pts progressed, 4 remained stable, 3 cannot be assessed
for response. At the end of entire treatment 22 patients (69%)
achieved complete/partial response,7 pts progressed (22%) and 3
cannot be assessed for response (2/3 not treated). 14/32 patients
died in median 1.1 months after the diagnosis of IA. Overall survival
(OS) with median follow-up of 32 months in surviving patients is
54% with statistical difference (log rank test p = 0.031) between
those with probable IA (OS 67%) or proven IA (OS 33%). 5/14
patients (36%) died in a direct consequence of IA, 4/14 patients died
due to progression of malignancy, 4 died of other reasons but IA was
considered as an important co-factor.
Conclusions IA is a life-threatening condition with high direct or
indirect negative influence on survival of children treated for malig-
nant disease. Only 33% of pediatric patients responded to first line
therapy with 69% complete/partial final response. Proven IA signifi-
cantly negatively influenced the overall survival.
Supported partly by the Czech Leukemia Study Group for Life and
MH CZ – DRO, University Hospital Motol Prague, CZ 00064203.

Abstract Number: p195

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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