Breakthrough Invasive Fungal Infections in Pediatric Acute Myeloid and Lymphoblastic Leukemia Receiving Mold-active Prophylaxis - PubMed
4 hours ago
- #pediatric leukemia
- #antifungal prophylaxis
- #invasive fungal infections
- Breakthrough invasive fungal infections (IFIs) remain a significant challenge in pediatric leukemia patients despite mold-active prophylaxis.
- The study included 147 pediatric patients (mean age 9.5 years) with acute leukemia, 68.0% with acute lymphoblastic leukemia (ALL) and 32.0% with acute myeloid leukemia (AML).
- All patients received mold-active prophylaxis, primarily voriconazole (84.4%).
- 29.3% of patients developed IFIs, classified as possible (81.4%), probable (11.6%), or proven (7.0%).
- Infection incidence was similar between ALL (29.0%) and AML (31.2%).
- Case-fatality rate was 16.3% (7/43), with higher mortality in probable (60.0%) and proven (66.7%) IFIs compared to possible (5.7%).
- Proven/probable infections were mainly caused by Aspergillus spp.
- The most used therapeutic agents were liposomal amphotericin B (43.2%) and caspofungin (30.9%).
- The study highlights the limitations of current prophylactic strategies and the need for optimized prophylaxis, therapeutic drug monitoring, and early diagnostic approaches.