Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Pediatric Infectious Disease, Istituto Giannina Gaslini, Genoa, Italy.
Eur J Haematol. 2017 Sep;99(3):240-248. doi: 10.1111/ejh.12910. Epub 2017 Jun 30.
Invasive fungal infection (IFI) is a cause of morbidity, mortality and increased health costs in children undergoing chemotherapy or hematopoietic stem cell transplant (HSCT).
Multicenter, retrospective study to assess the incidence, outcome of proven and probable IFI (PP-IFI) in children treated for acute leukemia, non-Hodgkin lymphoma or who underwent HSCT from 2006 to 2012.
Over the 7-year period, 127 PP-IFI were diagnosed in 123 patients, median age of 9.7 years. The 1-year cumulative incidence was 2.5% (CI 1.8-3.7) after frontline chemotherapy, 9.4% (CI 5.8-15.0) after relapse, and 5.3% (CI 3.9-7.1) after HSCT. Severe neutropenia was present in 98 (77%) patients. Culture-proven agents were Candida spp., mostly non-albicans, 28, mold 23, whereas three proven IFI were identified by histopathology. Favorable response to treatment within 3 months from diagnosis was observed in 77 (89%). The overall ninety-day probability of survival was 68% (CI 59-76).
About two-thirds of pediatric patients with PP-IFI survived, regardless of whether the infection occurred after frontline chemotherapy, reinduction chemotherapy for disease relapse, or after HSCT. Further prospective studies are needed to define the impact of antifungal prophylaxis and early combination therapy on short-term overall survival.
侵袭性真菌感染（IFI）是导致接受化疗或造血干细胞移植（HSCT）的儿童发病、死亡和增加医疗费用的原因。
采用多中心回顾性研究，评估 2006 年至 2012 年间接受急性白血病、非霍奇金淋巴瘤治疗或接受 HSCT 的儿童中确诊和可能侵袭性真菌感染（IFI）（PP-IFI）的发生率和结局。
在 7 年期间，123 例患者中诊断出 127 例 PP-IFI，中位年龄为 9.7 岁。一线化疗后 1 年累积发生率为 2.5%（95%CI 1.8-3.7），复发后为 9.4%（95%CI 5.8-15.0），HSCT 后为 5.3%（95%CI 3.9-7.1）。98 例（77%）患者存在严重中性粒细胞减少症。培养阳性的病原体为念珠菌属，主要为非白念珠菌，28 例，霉菌 23 例，而 3 例确诊的 IFI 通过组织病理学确定。诊断后 3 个月内治疗反应良好的有 77 例（89%）。90 天总生存率为 68%（95%CI 59-76）。
无论感染发生在一线化疗后、疾病复发的再诱导化疗后还是 HSCT 后，约三分之二的 PP-IFI 患儿存活。需要进一步的前瞻性研究来确定抗真菌预防和早期联合治疗对短期总生存率的影响。
