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Risk Factors for Invasive Fungal Infection in Children and Adolescents With Hematologic and Malignant Diseases

A 10-year Analysis in a Single Institute in Japan

Kobayashi, Ryoji, MD; Hori, Daiki, MD; Sano, Hirozumi, MD; Suzuki, Daisuke, MD; Kishimoto, Kenji, MD; Kobayashi, Kunihiko, MD

The Pediatric Infectious Disease Journal: December 2018 - Volume 37 - Issue 12 - p 1282–1285
doi: 10.1097/INF.0000000000002010
Immunology Reports

Infection, especially invasive fungal infection (IFI), is an important complication of chemotherapy and stem cell transplantation. It is also a well-known risk factor in pediatric hematologic malignancy, acute myelogenous leukemia, recurrent disease and allogeneic stem cell transplantation. We previously revealed that a diagnosis of acute myelogenous leukemia, recurrent disease and >10 years of age were risk factors for IFI in patients with pediatric hematologic malignancies. We examined and compared the incidence, risk factors and mortality rate from IFI between 276 patients from 2007 to 2016 and patients in our past report. The cumulative incidence of IFI was 10.5%; this comprised cases of probable and possible IFI at rates of 5.1% and 5.4%, respectively. Univariate analysis showed that age >9 years at admission, recurrent disease and acute myelogenous leukemia diagnosis were risk factors for IFI. Similar to the results of the previous study, multivariate analysis showed that each of these 3 variables was an independent predictor of IFI. The survival rate was lower in patients with IFI than in those without IFI (38.8% versus 69.9%; P < 0.001). However, IFI was a direct cause of death in only 2 patients. Although 11 patients received stem cell transplantation after IFI treatment, only 2 patients have survived, and the other 9 patients died of other complications.

From the Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Shiroishiku, Sapporo, Japan.

Accepted for publication January 31, 2018.

The authors have no conflicts of interest to disclose.

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Address for correspondence: Ryoji Kobayashi, MD, Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Higashi-Sapporo 6-6, Shiroishiku, Sapporo 003-0006, Japan. E-mail: r-koba@jacls.jp

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