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J Pediatr Infect Dis 2021; 16(05): 237-241
DOI: 10.1055/s-0041-1731041
Original Article

A Survival Analysis of Invasive Fungal Diseases in Children with Cancer

Letícia Maria Acioli Marques
1   Infection Control Committee, Institute of Pediatric Oncology - Support Group for Adolescents and Children with Cancer, Federal University of Sao Paulo, Sao Paulo, Brazil
,
Orlei Ribeiro de Araujo 
2   Intensive Care Unit, Institute of Pediatric Oncology - Support Group for Adolescents and Children with Cancer, Federal University of Sao Paulo, Sao Paulo, Brazil
,
Adriana Maria Paixão de Sousa da Silva
1   Infection Control Committee, Institute of Pediatric Oncology - Support Group for Adolescents and Children with Cancer, Federal University of Sao Paulo, Sao Paulo, Brazil
,
Dafne Cardoso Bourguignon da Silva
2   Intensive Care Unit, Institute of Pediatric Oncology - Support Group for Adolescents and Children with Cancer, Federal University of Sao Paulo, Sao Paulo, Brazil
,
Fabianne Altruda de Moraes Costa Carlesse
2   Intensive Care Unit, Institute of Pediatric Oncology - Support Group for Adolescents and Children with Cancer, Federal University of Sao Paulo, Sao Paulo, Brazil
3   Infection Control Committee, Institute of Pediatric Oncology - Support Group for Adolescents and Children with Cancer, Federal University of Sao Paulo, Sao Paulo, Brazil
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Abstract

Objective This study aimed to determine the survival in a retrospective cohort of 152 patients treated for invasive fungal diseases (IFD) (133 proven and 19 probable) in 9 years.

Methods Our study included patients aged 0 to 18 years diagnosed with cancer at our institution and with proven or probable IFD, treated from 2011 to 2019. Weibull distribution was used for hazard ratios and accelerated failure time models for the outcome “death attributed to IFD.”

Results Our median age was 97 months. The most frequent diagnosis was leukemia (39, 25.7%). A total of 37 patients received prophylaxis with fluconazole (24.3%). Among 133 fungal isolates, the most frequent were Candida species in blood 81 (53.2%). Moreover, 43 deaths were attributed to IFD (28.3%). Survival probabilities were lower for pulmonary IFD (46.9%, p = 0.0017), leukemia (62.5%, p = 0.004), and neutropenia <500 cells/mm3 (55.4%, p < 0.0001). For Candida fungemia, survival probabilities were 76.6% (p = 0.043). In Weibull models, the diagnosis of leukemia shortened survival times by a factor of 0.006, relapse of disease by 0.05, lymphoma by 0.04, pulmonary IFD by 0.04, and neutropenia by 0.015. Hematopoietic stem cell transplantation did not affect the survival times as well as prophylaxis with fluconazole.

Conclusion Host factors, such as neutropenia, relapse of disease, and hematologic malignancies, are determinants in the survival times of children with IFD as well as pulmonary involvement.

Keywords

fungi - cancer - survival analysis


Publication History

Received: 24 December 2020

Accepted: 11 April 2021

Article published online:
26 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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