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Original research article
Published online: 2021-04-20
Submitted: 2021-01-01
Accepted: 2021-01-18
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High risk of invasive fungal disease in children undergoing hematopoietic cell transplantation or complex anticancer therapy: the adverse role of post-transplant CMV replication

Jan Styczynski, Przemysław Gałązka, Krzysztof Czyżewski, Natalia Bartoszewicz, Joanna Cisek, Anna Dąbrowska, Ewa Demidowicz, Robert Dębski, Magdalena Dziedzic, Marlena Ewertowska, Elżbieta Grześk, Agnieszka Jatczak-Gaca, Andrzej Kołtan, Sylwia Kołtan, Piotr Księżniakiewicz, Monika Łęcka, Agata Marjańska, Monika Pogorzała, Monika Richert-Przygońska, Barbara Tejza, Anna Urbańczyk, Hanna Żołnowska, Mariusz Wysocki
DOI: 10.5603/AHP.a2021.0025

open access

Ahead of print
ORIGINAL RESEARCH ARTICLE
Published online: 2021-04-20
Submitted: 2021-01-01
Accepted: 2021-01-18

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 allo-HCT, 22.2% in PHO, and 6.0% in auto-HCT patients. 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: CMV replication, and acute and chronic graft-versus-host disease (GvHD). 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.

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 allo-HCT, 22.2% in PHO, and 6.0% in auto-HCT patients. 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: CMV replication, and acute and chronic graft-versus-host disease (GvHD). 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.

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Keywords

fungal infections, malignant diseases, pediatric hematology and oncology, hematopoietic cell transplantation, children

About this article
Title

High risk of invasive fungal disease in children undergoing hematopoietic cell transplantation or complex anticancer therapy: the adverse role of post-transplant CMV replication

Journal

Acta Haematologica Polonica

Issue

Ahead of print

Article type

Original research article

Published online

2021-04-20

DOI

10.5603/AHP.a2021.0025

Keywords

fungal infections
malignant diseases
pediatric hematology and oncology
hematopoietic cell transplantation
children

Authors

Jan Styczynski
Przemysław Gałązka
Krzysztof Czyżewski
Natalia Bartoszewicz
Joanna Cisek
Anna Dąbrowska
Ewa Demidowicz
Robert Dębski
Magdalena Dziedzic
Marlena Ewertowska
Elżbieta Grześk
Agnieszka Jatczak-Gaca
Andrzej Kołtan
Sylwia Kołtan
Piotr Księżniakiewicz
Monika Łęcka
Agata Marjańska
Monika Pogorzała
Monika Richert-Przygońska
Barbara Tejza
Anna Urbańczyk
Hanna Żołnowska
Mariusz Wysocki

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