Impact of Invasive Fungal Diseases on Treatment Outcomes in Pediatric Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma: Insights From a Single-Center Study

IF 2.4 3区医学 Q2 HEMATOLOGY

Pediatric Blood & Cancer Pub Date : 2025-03-06 DOI:10.1002/pbc.31643

Amrutha Narayana Murthy, Shyam Srinivasan, Vasundhara Patil, Gaurav Salunke, Chetan Dhamne, Nirmalya Roy Moulik, Maya Prasad, Badira C Parambil, Venkata Rama Mohan Gollamudi, Akanksha Chichra, Girish Chinnaswamy, Gaurav Narula, Shripad Banavali

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Abstract

Background and Aims

Invasive fungal diseases (IFD) in children with newly diagnosed acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) are poorly characterized, especially in lower–middle-income countries (LMICs). This study aims to identify the incidence, risk factors, and outcomes of IFD in a pediatric cohort with ALL/LBL.

Methods

We retrospectively analyzed pediatric patients diagnosed with ALL/LBL between January and December 2023 at a tertiary cancer center in India. Patients were risk-stratified and treated per the modified ICiCLe-ALL-14 protocol. IFDs were classified as proven, probable, and possible according to the revised EORTC/MSG consensus definition.

Results

Among 407 patients, 392(96%) had ALL. The overall incidence of IFD was 25%, with probable/proven infections in 12%. Mold infections predominated (79 cases, 77%), followed by yeast infections (21 cases, 21%). In comparison with patients without IFDs, those with IFDs were more likely to have received dexamethasone (30 vs. 20%; p = 0.009), anthracycline (28 vs. 14%; p = 0.001) during induction and have central venous access (27 vs. 18%; p = 0.008). The 6-week mortality rate of patients with IFD was 15%, rising to 26% in probable/proven cases. Coexisting bacterial infection was associated with increased mortality (odds ratio: 19.2[95%CI: 3.5–105]; p = 0.001).

Conclusion

IFDs are common in newly diagnosed ALL/LBL patients in LMICs, particularly during early phases of therapy. These infections are associated with considerable mortality, often compounded by concomitant bacterial sepsis. Given these findings, consideration of antifungal prophylaxis is warranted to mitigate morbidity and mortality due to IFDs.

Abstract Image

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背景与目的：新诊断的急性淋巴细胞白血病（ALL）和淋巴细胞淋巴瘤（LBL）患儿的侵袭性真菌病（IFD）特征不明显，尤其是在中低收入国家（LMICs）。本研究的目的是在患有ALL/LBL的儿科人群中确定IFD的发病率、风险因素和预后：我们回顾性分析了2023年1月至12月期间在印度一家三级癌症中心确诊为ALL/LBL的儿科患者。我们对患者进行了风险分级，并按照修改后的 ICiCLe-ALL-14 方案进行治疗。根据修订后的 EORTC/MSG 共识定义，IFD 被分为已证实、可能和可能：在407名患者中，392人（96%）患有ALL。IFD的总发病率为25%，可能/已证实感染占12%。霉菌感染占多数（79例，77%），其次是酵母菌感染（21例，21%）。与无 IFD 的患者相比，IFD 患者更有可能在诱导期间接受地塞米松（30 对 20%；P = 0.009）和蒽环类药物（28 对 14%；P = 0.001）治疗，并有可能使用中心静脉通路（27 对 18%；P = 0.008）。IFD患者的6周死亡率为15%，可能/已证实病例的死亡率上升至26%。合并细菌感染与死亡率增加有关（几率比：19.2[95%CI：3.5-105]；P = 0.001）：结论：IFD在低收入国家新确诊的ALL/LBL患者中很常见，尤其是在治疗的早期阶段。这些感染会导致相当高的死亡率，而且往往会并发细菌性败血症。鉴于这些发现，有必要考虑采取抗真菌预防措施，以降低IFD导致的发病率和死亡率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Blood & Cancer 医学-小儿科

CiteScore

4.90

自引率

9.40%

发文量

546

审稿时长

1.5 months

期刊介绍： Pediatric Blood & Cancer publishes the highest quality manuscripts describing basic and clinical investigations of blood disorders and malignant diseases of childhood including diagnosis, treatment, epidemiology, etiology, biology, and molecular and clinical genetics of these diseases as they affect children, adolescents, and young adults. Pediatric Blood & Cancer will also include studies on such treatment options as hematopoietic stem cell transplantation, immunology, and gene therapy.