Purpose: To compare the incidence, microbiology and outcome of invasive aspergillosis (IA) in children treated for acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) at our institution before and after the use of routine voriconazole prophylaxis. Methods: We compared children with AML/MDS who received voriconazole as antifungal prophylaxis through their chemotherapy course (VORI) with a historic cohort of children from the previous protocol who did not receive prophylaxis (NON VORI). We defined IA as per the EORTC/MSG criteria for proven and probable fungal infections. Data for children who completed their chemotherapy protocol without complications was censored at 220 days, the time at which prophylaxis was discontinued. Patients from both groups who underwent hematopoietic stem cell transplant (HSCT) for relapse or recurrence of their disease were analyzed separately. Results: There were a total of 104 patients in the VORI protocol and 102 in the NON VORI comparison group. During the course of regular chemotherapy there were nine cases of IA in the NON VORI group: 2 due to Aspergillus fumigatus and six to Aspergillus flavus; one patient had infection with both organisms. In contrast, there was only one probable case of IA and no culture proven cases in the VORI group (p=0.0026). At 90 days after diagnosis, there were 2 deaths attributable to IA in the NON VORI group and none in the VORI group (p=0.2447). Of the 32 NON VORI patients who underwent HSCT, nine (28%) presented with culture proven IA, which included infections by Aspergillus flavus (5), Aspergillus fumigatus (3) and Aspergillus terreus (1). Among the 33 VORI patients who underwent HSCT, only 3 patients (9%) had probable IA. Eight patients in the NON VORI HSCT group died of IA, compared to only 1 patient in the VORI HSCT group (p=0.0129). Conclusions: There was a statistically significant reduction in the incidence of IA in AML/MDS patients after the initiation of routine use of voriconazole prophylaxis. Patients with IA in the VORI group had more favorable outcomes and lower mortality than that of the comparison group and that reported in the adult literature.
Full conference title:
4th Advances Against Aspergillosis
- AAA 4th (2010)