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- Title
High risk of invasive fungal disease in children undergoing hematopoietic cell transplantation or complex anticancer therapy: adverse role of post-transplant CMV replication.
- Authors
Styczyński, Jan; Gałązka, Przemysław; Czyżewski, Krzysztof; Bartoszewicz, Natalia; Cisek, Joanna; Dąbrowska, Anna; Demidowicz, Ewa; Dębski, Robert; Dziedzic, Magdalena; Ewertowska, Marlena; Grześk, Elżbieta; Jatczak-Gaca, Agnieszka; Kołtan, Andrzej; Kołtan, Sylwia; Księżniakiewicz, Piotr; Łęcka, Monika; Marjańska, Agata; Pogorzała, Monika; Richert-Przygońska, Monika; Tejza, Barbara
- Abstract
Introduction: We analyzed the epidemiology and outcomes of treatment of invasive fungal disease (IFD) in children during anticancer therapy (PHO, pediatric hematology and oncology) or after hematopoietic cell transplantation (HCT) over a period of eight consecutive years in a single-center study. Material and methods: Overall, a total of 254 HCTs were performed, and 415 children were newly diagnosed for malignancy. Incidence, epidemiology and outcome of IFD were analyzed. Results: The cumulative incidence of any IFD was 32.6% in allogeneic hematopoietic cell transplantation (allo-HCT), 22.2% in PHO, and 6.0% in autologous hematopoietic cell transplantation patients (auto-HCT). The incidence of proven +probable IFD was 12.6%, 10.4%, and 6.0%, respectively. As many as 77.0% HCT and 67.4% PHO of fungal episodes occurred in acute leukemia patients: the highest incidence of any IFD was observed for acute lymphoblastic leukemia (29.3% in HCT; 40.5% in PHO) and for acute myeloblastic leukemia (51.1% in HCT; 65.0% in PHO) patients. There were no significant differences in the incidence of fungal infections in both allo-HCT and PHO patients between the 2-year periods. Factors contributing to an increased risk of IFD in allo-HCT patients were: cytomegalovirus replication, and acute and chronic graft-versus-host disease. Survival from IFD was 91.9% in PHO, and 78.1% in HCT patients. Fungal pneumonia in HCT patients resolved in 62.9%, while in PHO patients it resolved in 93.5%. Conclusions: The risk of IFD in allo-HCT patients is much higher than in auto-HSCT and PHO patients. The outcome of IFD is better in PHO and auto-HCT than in allo-HCT settings.
- Subjects
MYCOSES; PEDIATRIC hematology; TUMORS in children; HEMATOPOIETIC stem cell transplantation; CANCER treatment
- Publication
Acta Haematologica Polonica, 2021, Vol 52, Issue 5, p483
- ISSN
0001-5814
- Publication type
Article
- DOI
10.5603/AHP.a2021.0025