The impact of IMI on patient mortality
The overall survival of children with hematologic malignancy and IMI was 57% (35 out of 61 have survived to date, with a minimum of two years of follow up since cancer diagnosis). For the 11 AML cases with IMI, only 3 survived (27%), and for the 45 ALL cases with IMI, 30 survived (67%). Of the 61 IMIs diagnosed between 2006 and 2020, 14 occurred in patients with relapsed/refractory leukemia or lymphoma, and 47 occurred in patients who were in clinical remission. Unsurprisingly, 12/14 (86%) relapsed/refractory patients died, vs. 14/47 (30%) patients who were in remission at the time of their IMI diagnosis (p=0.0002). Eighteen out of the 26 patients who died had active fungal disease at the time of their death (69%). There was no notable difference in mortality risk pre- and post-implementation of the TCH antifungal algorithm. Of the 47 IMI cases diagnosed from 2006-2015, 20 (43%) died and 13 (65%) had active fungal disease at the time of their death. Out of the 14 IMI cases diagnosed from 2016-2020: 6 (43%) died and 5 (83%) had active fungal disease at the time of their death.