ABSTRACT
Background: Children with hematologic malignancies, especially
those who receive intensive chemotherapy, are at high risk for invasive
mold infections (IMI) that confer substantial mortality. Randomized
controlled trials support the use of antifungal prophylaxis with
anti-mold activity as an optimal strategy for risk reduction in this
population, but studies outlining the practical application of
evidence-based recommendations are lacking.
Procedure: We conducted a 15-year, single-institution
retrospective review of children with hematologic malignancies treated
with chemotherapy to determine the incidence of proven or probable IMI
diagnosed between 2006 and 2020 and to identify the host and disease
factors associated with IMI risk. We then compared the incidence and
type of IMI and related factors before and after 2016 implementation of
an evidence-based, risk-adapted antifungal prophylaxis algorithm that
broadened coverage to include molds in patients at highest risk for IMI.
Multivariable linear regression was used to determine factors related to
IMI risk.
Results: We identified 61 cases of proven or probable IMI in
1,456 patients diagnosed with hematologic malignancies during the study
period (4.2%). Implementation of an antifungal prophylaxis algorithm
reduced the IMI incidence in this population from 4.8% to 2.9%. After
multivariable analysis, both Hispanic ethnicity and cancer diagnosis
prior to 2016 were significantly associated with risk for IMI.
Conclusion: An evidence-based, risk-adapted approach to
antifungal prophylaxis for children with hematologic malignancies is an
effective strategy to reduce incidence of IMI.