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Treatment of Invasive Fungal Disease During Therapy for Acute Lymphoblastic Leukemia: A Case report
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  • Yasser B. Hennawi,
  • Ibrahim Alharbi,
  • Amro Nassif,
  • Marwa Farhan
Yasser B. Hennawi
Umm Al-Qura University College of Medicine

Corresponding Author:[email protected]

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Ibrahim Alharbi
King Fahd Armed Forces Hospital
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Amro Nassif
King Fahd Armed Forces Hospital
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Marwa Farhan
Cairo University
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Background: Invasive fungal Disease (IFDs) are one of the leading causes of death in acute leukaemia patients (AL). Because of the possibility of fungal relapse, patients who survive invasive fungal illnesses may have difficulty completing the whole chemotherapy plan. Objectives: To present two cases of Pre-B Acute Lymphoblastic Leukemia complicated with Invasive fungal infection with Aspergillosis. Methods: Two 9 years old female patients diagnosed with Pre-B Acute Lymphoblastic Leukemia that was on the pre-B ALL Protocol: CALL08, Arm-C (High Risk Arm) and the supportive therapy. They were both on Arm C of the CALL08 Protocol (high Risk based on COG232). Then, the patients experienced severe febrile neutropenia. Patient A was during consolidation and patient B during Interim Maintenance I. Both experienced prolonged febrile neutropenia. As Febrile neutropenia continues > 5 days, fungal work was done including CT Sinuses, Chest, and abdomen as well as serum galactomannan, and ( 1- 3)- β- d- glucan (BG). caspofungin was started. Fungal work up results showed lung and liver nodules in one patient and lungs, liver and spleen in the other. There were about 4 weeks of severe fevers and neutropenia despite broad spectrum antibiotics used. A decision was taken to interrupt chemotherapy for both patients. voriconazole was added to caspofungin and continued on meropenem. Biopsies confirmed the diagnosis to be severe fungal infection with Invasive Aspergillosis. After that, high fevers and neutropenia slowly recovered and repeated CT Abdomen showed good improvement in the lesions number and size. After 6-8 weeks of interruption, chemotherapy was resumed. Results: With combination therapy with voriconazole & caspofungin for 6 weeks then single therapy (voriconazole orally) for another 6 weeks, the patients become stable and afebrile. Chemotherapy was on hold till they become better. Conclusion: antifungal primary and secondary prophylaxis are recommended for ALL patients. Chemotherapy discontinuation is decided on an individual basis according to the severity of the fungal infection and disease status.