Impact of invasive fungal infections on treatment outcomes in pediatric
acute lymphoblastic leukemia and lymphoblastic lymphoma: Insights from a
single-center study
Abstract
Background And Aims: Invasive fungal infections (IFI) in
children with newly diagnosed acute lymphoblastic leukemia (ALL) and
lymphoblastic lymphoma (LBL) are poorly characterized, especially in
lower-middle income countries (LMICs). This study aims to identify the
incidence, risk factors and outcomes of IFI in a pediatric cohort with
ALL/LBL. Methods: We retrospectively analysed pediatric
patients diagnosed with ALL/LBL between January and December 2023 at a
tertiary cancer center in India. Patients were risk-stratified and
treated per the modified ICiCLe protocol. IFIs were classified as
proven, probable and possible according to the revised EORTC/MSG
consensus definition. Results: Among 407 patients, 392 (96%)
had ALL. The overall incidence of IFI was 24%, with probable/proven
infections in 12%. Mold infections predominated (79 cases, 77%),
followed by yeast infections (21 cases, 21%). In comparison to patients
without IFIs, those with IFIs were more likely to have received
dexamethasone (30% vs 20%; p=0.009) and anthracycline (28% vs 14%;
p=0.001) during induction. Chemotherapy interruptions occurred in 56%
of IFI cases, impacting treatment continuity. The 6-week mortality rate
of patients with IFI was 15%, rising to 26% in probable/proven cases.
Coexisting bacterial infection was associated with increased mortality
(odds ratio: 19.2[95%CI: 3.5-105]; p=0.001). Conclusion:
IFIs are common in newly diagnosed ALL/LBL patients in LMICs,
particularly during early phases of therapy. These infections are
associated with considerable mortality, often compounded by concomitant
bacterial sepsis. Given these findings, consideration of antifungal
prophylaxis is warranted to mitigate morbidity and mortality due to
IFIs.