Objective: Study of Invasive Fungal Infections (IFIs) and analysis of antifungal prescribing practices in children treated with antimitotic chemotherapy for cancer in hematology and pediatric oncology Montpellier University Hospital over a period of 3 years.
Methods: Retrospective analysis, from January 2004 to December 2006, antifungal prescriptions, prophylactic treatment classification, empirical, preemptive or curative according to the clinical, biological and radiological, and epidemiological analysis of IFI.
Results: We diagnosed 173 cancers: Acute Leukemias 59 (LA), 21 lymphomas and 93 Solid Tumours (TS).
Sixty four antifungal prescriptions were made: 7 primary prophylaxis for bone marrow transplantation (6 prescriptions in children followed for LA, 1 lymphoma), 7 secondary prophylaxis after cured IFIs (6 LA, 1 lymphoma), 27 empirical treatment (17 LA, 5 lymphomas, 5 TS) and 4 preemptive treatment (TS 4). Nineteen children received curative treatment: 13 (68%) IFIs have occurred in children followed for LA (10 induction of antimitotic treatment, 1 in allograft, 2 other) at 4 lymphoma (1 induction, 2 allograft, 1 other) and 2 at a TS (1 in induction, 1 other).
The mushrooms were 11 Aspergillus species (58%), 6 Candida species (32%), 1 Cryptococcus neoformans and 1 zygomycete.
Twenty-three children died including 3 deaths are related to an IFI. These three children have had invasive aspergillosis in induction treatment for Acute Leukemia.
Liposomal amphotericin B (3-5 mg / kg / day) was prescribed first line in 32 cases, voriconazole (7 mg / kg / d) 14 times and caspofungin (50 mg / m 2 / d) 18 time. Eight patients with proven IFI received antifungal association.
Conclusions: In our pediatric experience, IFIs occur preferably during the induction of mitotic treatment for Acute Leukemia. Aspergillus, the most common fungus is responsible for 3 deaths in induction treatment for LA.Strict monitoring should be performed during this phase of treatment.
Full conference title:
- RICAI 27th (2007)