Survival after IFD in children undergoing antineoplastic chemotherapy or stem-cell transplant

Invasive fungal disease (IFD) are severe complications in children undergoing chemotherapy or hematopoietic stem cell transplantation (HSCT). Aim of this study is to evaluate factors related with long-term survival in a pediatric population followed at Istituto Giannina Gaslini Children Hospital, from 2006 to 2016.
Following data were prospectively collected: demographics; underlying disease, treatment phases (1st diagnosis; resistant/relapsing disease; autologous HSCT, allogeneic HSCT form alternative or matched related donor, HSCT rejection/failure, acute Graft vs. Host Disease (GvHD) grade 0-I or II-IV, chronic extensive GvHD); type of fungus (yeast or mold), diagnosis of IFD according to EORTC/MSG criteria. 108 IFD were diagnosed in 102 patients. Proven IFD were 46%, probable 27% and possible 27%. During the observation 38% children died: 67% within 3 months from IFD, 25% within 6 and 8% in 12. Risk for death was 24% at 3 months, 33% at 6 and 37% at 12. Treatment phase was the only variable predicting mortality at 3, not at 6 and 12 months. Hazard ratio was significant for relapsing/resistant disease, HSCT rejection, aGvHD grade II-IV, extended cGvHD. With the available management strategies, in children undergoing chemotherapy or HSCT developing IFD, mortality is associated with treatment phase. Further studies are needed to understand if mortality could be reduced by increasing antifungal therapies and/or increasing treatment of the underlying conditions.

Alessio Mesini
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