BACKGROUND. Invasive fungal disease (IFD) is a significant cause of morbidity and mortality in immunosuppressed children. We aim to describe the epidemiology and clinical parameters of IFD in a Pediatric Hematology-Oncology Unit (PHOU) with an increasing activity during the last 14 years. METHODS. We retrospectively reviewed the medical records of children (up to 18 years old) admitted for IFD to the PHOU of a tertiary hospital in Madrid (Spain), between 2006-2019. Epidemiological, diagnostic and therapeutic parameters were compared according to the type of infection, study period (considering 3 equivalent time fractions) and outcome. RESULTS. Twenty-eight episodes of IFD occurred in 27 out of 471 children at risk (13 males, median 10 years old). Five episodes of candidemia (all in the first period) and 23 bronchopulmonary mold diseases were registered. Six (21.4%), eight (28.6%) and 14 (50%) episodes met criteria for proven, probable and possible IFD, respectively. Most episodes (71.4%) occurred in high-risk children receiving antifungal prophylaxis. Eight children required intensive care and six died during treatment. Mold infections occurred in older children (126 vs. 21 months; p=0,045), increased over time (p=0.002) and were more common in high-risk compared to low-risk children (87% vs. 0%; p=0.001). There were no differences in mortality rates between periods, types of infection or underlying conditions. CONCLUSIONS. Yeast infections decreased within the study time and mold infections were more frequent in high-risk patients. A rising activity in our PHOU and an increase in the complexity of pathologies were not followed by an increase in mortality rates.

BACKGROUND The use of azoles for antifungal prophylaxis after familial allogeneic stem cell transplantation in children (SCT) is hindered by adverse events and drug interactions especially in children affected by sickle cell disease. Intermittent, higher dose of micafungin could be an alternative. METHODS A prospective, observational, longitudinal, single-center study was conducted between May 2015 and June 2018. The study included 30 patients between 2 and 18 years old who underwent allogeneic SCT and received prophylaxis with micafungin on alternating days after the bone marrow engraftment phase. FINDINGS Fifty transplants performed, 30 included prophylaxis against IFIs, with micafungin in an alternating pattern according to the previously described protocol. The indication for HSCT was hemoglobinopathies in 76.7%, acute leukemia in 20.0% and Fanconi anemia in 3.3%. The prophylaxis duration was 2.33 months (1.53 to 3.98). In our study, 40.0% (12/30) of the patients had acute GVHD, and 6.7% (2/30) had chronic GVHD, which prolonged the duration of alternating prophylaxis. No serious adverse effects of the use of micafungin were observed in any of the patients. There was also no breakthrough Invasive fungal infection (IFI) during alternating prophylaxis. CONCLUSION: In selected patients, micafungin was well tolerated without breakthrough IFI in our study.