Materials and Methods
A retrospective study was conducted at ’Health Science University Ankara
Children’s Hematology Oncology Training and Research Hospital’ from
January 2014 until December 2017. Patients under 18 years of age with a
hematological malignancy (acute lymphoblastic or myeloblastic leukemia)
diagnosed as IFI were enrolled. Basic demographic data, underlying
conditions, neutropenia (absolute neutrophil count <500
cells/μL) durations, radiological findings, antifungal medications and
side effects, and outcomes were noted. Galactomannan (GM) enzyme
immunoassay (Platelia Aspergillus, BioRad, France) analysis in plasma
were obtained in the presence neutropenic fever and IFI episode twice
weekly, and ≥0.5 were considered positive. All patients received
prophylactic antifungal agents according to their primary disease
protocol, and the risk or history of IFI. Diagnosis of IFI was defined
acording to the criteria of the European Organization for Research and
Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the
National Institute of Allergy and Infectious Disease Mycoses Study Group
(EORTC/MSG).16 Patients were grouped according to a
diagnosis of proven, probable, or possible IFI. Empirical antifungal
treatment was initiated if fever persisted for more than 96 hours after
initiation of empiric antibacterial treatment considering
guidelines.17,18 If there were symptoms, signs,
laboratory or radiological findings suggestive of invasive fungal
infection, antifungal therapy was initiated earlier than the
above-mentioned period. CAT was initiated based on the patient’s IFI
condition and clinician’s subjective decision. The day of diagnosis was
defined as the day that the clinician confirmed diagnosis of IFI, and
onset the antifungal treatment. Response to treatment was defined
according to criteria of EORTC/MSG.16 Overall response
rate and overall survival rate based on 12 weeks were recorded. Research
ethics board approval was obtained for the study from the local ethics
committee of institution.
Statistical analysis was performed using SPSS v25.0 (IBM Corp., Armonk,
New York, USA) statistical package. Categorical variables were compared
by chi-square or Fisher exact tests, and were summarized with
frequencies. For continuous variables, median and interquartile range
(IQR) were calculated. Group comparisons were carried out using
independent samples t-test or Mann–Whitney U-tests, and Kruskal-Wallis
test if appropriate. All tests were 2-sided with a significance level of
0.05.