Introduction: Invasive fungal infections (IFI) are a major cause of mortality and morbidity among pediatric patients receiving hematopoietic stem cell transplantation (HSCT). Diagnosis and treatment of IFI are complex, so that it becomes necessary to know those features that allow to identify patients at high risk. Publications reporting data about IFI risk factors in pediatric population are scanty.
Materials (or patients) and methods: We retrospectively analyzed medical records from children with oncohematological disorders who underwent HSCT in a reference Pediatric Oncology Service of a tertiary hospital between January 1991 and December 2013. We defined IFI cases based on current EORTC/MSG criteria. In our centre, we use fluconazol prophylaxis in autologous HSCT from the beginning of mucositis until neutropenia resolves. In allogeneic HSCT, we use voriconazol prophylaxis from the end of the conditioning to the immunosuppressants withdrawal. Since 2009, we twice-weekly do serum galactomanan leves in all HSCT patients during the more risky period.We initially described the incidence and epidemiological features of the different kinds of IFI in our centre. We also carried out an univariate analysis and subsequently a binary logistic regression in an attempt of identify risk factors for IFI.
Results: The study population includes 403 pacients who underwent 445 HSCT. The median age was 7,26 years (±4,42). Acute Leukemia was the most frequent diagnosis (55,7% of HSCT). Autologous HSCT was the most common (66%). Sixteen percent of patients suffered from acute graft versus host disease (aGVHD) whereas 4,3% did it from the chronic form (cGVHD). We observed an overall incidence of IFI of 3,4%. Invasive Aspergillosis was the more frequent kind of IFI with 12 cases (incidence of 2,7%). Pulmonary Aspergillosis was the most frequent presentation form (75% of cases). Overall mortality was 44,9% among patients who underwent HSCT but 68% in the IFI group. Patients with a prior diagnosis of lymphoma showed the higher risk for IFI with an Odds Ratio (OR) 25 (2,18-306,98).
Conclusion: In our centre, we found an incidence and mortality of IFI similar to that communicated in the literature. As in other centers, after using azole prophylaxis, number of Candida infections has decreased and Aspergillosis is the most frequent IFI. In the univariate analysis, prior diagnosis of lymphoma, allogeneic HSCT, and aGVHD were significantly related to the presence of IFI. After binary logistic regression only the diagnosis of lymphoma was risk factor for IFI with an Odds Ratio (OR) 25 (2,18-306,98). This could be explained by the presence of two cases of candidiasis among only 16 patients with lymphoma. Allogeneic HSCT, specially blood cord and haploidentical transplantation, showed trends of being a risk factor for IFI though it didn’t reach statistical significance.
References: 1. Srinivasan A, Wang C, Srivastava DK, et al. Timeline, epidemiology, and risk factors for bacterial, fungal, and viral infections in children and adolescents after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2013;19:94-101.
2. Castagnola E, Faraci M, Moroni C, et al. Invasive mycoses in children receiving hemopoietic SCT. Bone Marrow Transplant 2008;41 Suppl 2:S107-11.
Full conference title:
- EBMT 41st (2015)