Ricard Noémi, Zebali Lelia, Renard Cécile, Goutagny Marie-Pierre, Benezech Sarah, Bertrand Yves, Philippe Michael, Domenech Carine
Centre Léon Bérard, Pharmacy Department, 69008 Lyon, France.
The Pediatric Hematology and Oncology Institute, Hospices Civils de Lyon, Université Lyon 1, 69008 Lyon, France.
Cancers (Basel). 2023 Mar 31;15(7):2107. doi: 10.3390/cancers15072107.
Allogenic hematopoietic stem cell transplantation (a-HCT) remains a therapeutic treatment for many pediatric hematological diseases. The occurrence of invasive fungal infections (IFIs) is a complication for which ECIL-8 recommends primary antifungal prophylaxis. In this study, we evaluated the impact of our local strategy of not systematically administering primary antifungal prophylaxis in children undergoing a-HCT on the occurrence and mortality of IFIs.
We performed a retrospective monocentric study from 2010 to 2020. We retained all proven and probable IFIs diagnosed during the first year post a-HCT.
308 patients were included. Eighteen patients developed twenty IFIs (thirteen proven, seven probable) (6.5%) among which aspergillosis ( = 10, 50%) and candidosis ( = 7, 35%) were the most frequently diagnosed infections. Only 2% of children died because of an IFI, which represents 14% of all deaths. Multivariate analysis found that age > 10 years (OR: 0.29), the use of a therapeutic antiviral treatment (OR: 2.71) and a low neutrophil count reconstitution (OR: 0.93) were significantly associated with the risk of IFI occurrence. There was also a trend of malignant underlying disease and status ≥ CR2 but it was not retained in multivariate analysis.
IFI occurrence was not higher in our cohort than what is reported in the literature with the use of systematic antifungal prophylaxis, with a good survival rate nonetheless. Thus, a prophylaxis could be considered for children with a high risk of IFI such as those aged over 10 years.
异基因造血干细胞移植（a-HCT）仍然是许多儿童血液疾病的一种治疗方法。侵袭性真菌感染（IFI）的发生是一种并发症，欧洲感染性疾病学会-8（ECIL-8）建议进行一级抗真菌预防。在本研究中，我们评估了我们当地对接受a-HCT的儿童不系统给予一级抗真菌预防的策略对IFI发生和死亡率的影响。
我们进行了一项2010年至2020年的回顾性单中心研究。我们纳入了所有在a-HCT后第一年诊断出的确诊和疑似IFI病例。
共纳入308例患者。18例患者发生了20例IFI（13例确诊，7例疑似）（6.5%），其中曲霉病（n = 10，50%）和念珠菌病（n = 7，35%）是最常诊断出的感染。仅有2%的儿童因IFI死亡，占所有死亡病例的14%。多因素分析发现，年龄>10岁（OR：0.29）、使用治疗性抗病毒治疗（OR：2.71）和中性粒细胞计数恢复缓慢（OR：0.93）与IFI发生风险显著相关。潜在恶性疾病和状态≥CR2也有一定趋势，但在多因素分析中未被纳入。
我们队列中IFI的发生率并不高于文献报道的使用系统性抗真菌预防的发生率，尽管如此，生存率良好。因此，对于IFI高风险儿童，如10岁以上儿童，可考虑进行预防。
