PB2034 INVASIVE ASPERGILLOSIS IN PEDIATRIC PATIENTS WITH MALIGNANCIES

Abstract

Background:Invasive aspergillosis (IA) is an important cause of infectious morbidity and mortality in immunocompromised pediatric patients. Early recognition and initiation of antifungal treatment are key to the infection control and possibility to continue anticancer treatment.Aims:To evaluate risk factors and treatment results of IA in children with malignancies.Methods:Retrospective analysis of the pediatric register of IA in malignancies from 1997 to January 2019. For the probable and proven IA diagnosis EORTC / MSG, 2008 criteria were used.Results:46 pediatric patients with malignancies were included, median age ‐ 8 years, males – 69,5%. IA was diagnosed after cytostatic chemotherapy in 42 patients (91,3%), in debut of cancer prior to chemotherapy – 4 (8,7%). Hematological malignancies were underlying diseases in 39 patients (84,7%), solid tumors – 7 (15,2%). Most frequent hematological diagnoses were myeloid leukemia (34,7%) and acute lymphoblastic leukemia (34,7%). Among solid malignancies – central nervous system tumors (42,8%). Risk factors of IA were prolonged ≥10 days neutropenia – 82,6%, steroid therapy – 50%, long‐term lymphocytopenia – 45,6%, severe bacterial infections (30,4%), and cytomegalovirus infection (8,8%). Main site of IA were lungs (89,1%), clinical signs were non‐specific. Typical imaging findings included the halo sign – 32,6% and air crescent sign – 4,3%. Galactomannan test in bronchoalveolar lavage fluid was positive in 83 %, in serum and cerebrospinal fluid – 37%. Mycological examination of specimen was attempted in 25% of patients. Among them septated hyphae by microscopy was diagnosed in 20%. Aspergillus spp. were isolated in culture in 28%. The etiology agents were A.fumigatus – 57%, A.niger – 29%, and A.ustus – 14%. Antifungal treatment received 100% of patients, with voriconazole only – 54,3%. 12‐week survival was 81%. In all cases of IA before chemotherapy after infection control anticancer therapy was continued. 63% of patients continued antifungal therapy concomitantly chemotherapy, voriconazole was canceled during vincristine use.Summary/Conclusion:Cases of IA in children with hematological malignancies were registered more frequently compared to solid tumors (84,7% vs 15,2%). The main risk factors of IA were prolonged neutropenia (82,6%), steroid therapy (50%), lymphocytopenia (45,6%). 12‐weeks overall survival was 81%. There were no contraindications for anticancer therapy to continue after infection control. In cases of continuation of antifungal treatment drug‐drug interactions should be considered.