Invasive Aspergillosis in Children With Acute Leukemia at a Resource-limited Oncology Center

Background: Invasive aspergillosis (IA) is one of the most feared complications in patients with hematologic malignancies because it is associated with high morbidity and mortality, and significantly compromises antileukemia therapy. Objectives: Analyze all patients with acute leukemia and IA of less than 18 years of age, diagnosed between January 1996 and December 2011. Materials and Methods: Cases were identified from the pediatric database for demographic details, disease characteristics, and IA-related data. Results: Among 356 patients with acute leukemia, 34 were identified to have proven/probable IA (5/29) with a relative incidence of 9% (28/310) and 13% (6/46) among acute lymphoblastic leukemia (ALL) and acute myeloid leukemia, respectively. Incidence of IA was significantly higher after 2004 especially among ALL patients; older patients with hyperglycemia and high-risk disease were more predisposed. None of the risk factors or type of antifungal treatment predicted mortality. The 120-day aspergillus-attributable mortality rate was 14.7%. IA led to a median of 17 days (2 to 44 d) of additional hospital stay and contributed to delay or reduction in planned chemotherapy in 30/34 patients. Conclusions: An increasing trend in incidence of IA was observed during the latter half of study period. Early empiric therapy led to modest aspergillus-free survival. Clinical and financial implications of IA mandate review of institutional antifungal prophylaxis policy especially in selected ALL patients during induction.