Invasive Aspergillosis in Pediatric Oncology Patients: A Rare Event With Poor Prognosis – Case Analysis to Plan Better Targeted Prophylactic or Therapeutic Measurement

F. Babor; F. Schuster; C. Mackenzie; R. Meisel; J. Schaper; H. Sabir; M. Siepermann; R. Wessalowski; G. Janßen; A. Borkhardt; H.-J. Laws

doi:10.1055/s-0032-1304625

Klin Padiatr 2012; 224(03): 160-165
DOI: 10.1055/s-0032-1304625

Original Article

Invasive Aspergillosis in Pediatric Oncology Patients: A Rare Event With Poor Prognosis – Case Analysis to Plan Better Targeted Prophylactic or Therapeutic Measurement

Invasive Aspergillose bei pädiatrischen hämatoonkologischen Patienten: Eine seltene Erkrankung mit schlechter Prognose – Eine Fallanalyse zur Planung von besser gezielten prophylaktischen und therapeutischen Maßnahmen

F. Babor

¹Department of Pediatric Oncology, Hematology and Immunology, Center for Child and Adolescent Health, Heinrich-Heine-University, Duesseldorf, Germany

,

F. Schuster

¹Department of Pediatric Oncology, Hematology and Immunology, Center for Child and Adolescent Health, Heinrich-Heine-University, Duesseldorf, Germany

,

C. Mackenzie

²Institute of Medical Microbiology and Hospital Hygiene, Heinrich Heine-University, Duesseldorf, Germany

,

R. Meisel

¹Department of Pediatric Oncology, Hematology and Immunology, Center for Child and Adolescent Health, Heinrich-Heine-University, Duesseldorf, Germany

,

J. Schaper

³Institute of Radiology, Heinrich Heine-University, Duesseldorf, Germany

,

H. Sabir

⁴Department of General Pediatrics, Heinrich Heine-University, Duesseldorf, Germany

,

M. Siepermann

¹Department of Pediatric Oncology, Hematology and Immunology, Center for Child and Adolescent Health, Heinrich-Heine-University, Duesseldorf, Germany

,

R. Wessalowski

¹Department of Pediatric Oncology, Hematology and Immunology, Center for Child and Adolescent Health, Heinrich-Heine-University, Duesseldorf, Germany

,

G. Janßen

¹Department of Pediatric Oncology, Hematology and Immunology, Center for Child and Adolescent Health, Heinrich-Heine-University, Duesseldorf, Germany

,

A. Borkhardt

¹Department of Pediatric Oncology, Hematology and Immunology, Center for Child and Adolescent Health, Heinrich-Heine-University, Duesseldorf, Germany

,

H.-J. Laws

¹Department of Pediatric Oncology, Hematology and Immunology, Center for Child and Adolescent Health, Heinrich-Heine-University, Duesseldorf, Germany

› Author Affiliations

Abstract

Background:

Despite the implementation of new antifungal drugs, invasive aspergillosis (IA) still remains a considerable challenge in pediatric oncology with a severe mortality. Prophylactic and therapeutic measurement have to be evaluated in these rare but poor prognostic patients. Therefore the entire group of patients at risk of developing IA has to be defined before cooperative prospective trials.

Methods:

In a retrospective analysis including all our patients with malignancies we looked for patients with proven/probable IA. Cases of the period from 2003 to 2008 were analyzed in detail.

Results:

In the period between 2003 to 2008 24 of 755 patients were affected by proven/ probable IA. Compared to former studies incidence increased from 1.3%in 1980 to 3.4% in 2008. AML patients with or without allogeneic/haploidentical stem cell transplantation were at highest risk (24% and 25% respectively, in comparison to 1% in ALL-patients). Survival after 2 years was 50% for patients with AML and IA.

Conclusion:

In patients with high risk to develop IA the effect of intensified, intravenous antimycotic prophylaxis has to be proven prospectively in a cooperative and randomized setting.

Zusammenfassung

Hintergrund:

Trotz der Einführung neuer antimykotischer Medikamente ist die invasive Aspergillose (IA) nach wie vor ein beträchtlicher Risikofaktor in der pädiatrischen Onkologie mit einer erheblichen Mortalitätsrate. Prophylaktische und therapeutische Maßnahmen müssen in dieser seltenen, aber prognostisch ungünstigen Patientengruppe untersucht werden. Zu diesem Zweck sollte zuvor die gesamte Risikogruppe für kooperative prospektive klinische Studien klar definiert sein.

Methode:

In einer retrospektiven Analyse aller pädiatrischen Patienten mit Malignomen wurden alle Patienten mit gesicherter/wahrscheinlicher IA identifiziert und analysiert, die zwischen 2003 und 2008 behandelt wurden. Ergebnisse: Im Zeitraum von 2003 bis 2008 waren 24 von 755 behandelten Patienten von einer gesicherten/wahrscheinlichen IA betroffen. Im Vergleich zu einer früheren Analyse stieg die Inzidenz der IA von 1.3% im Jahr 1980 auf jetzt 3.4%. Bei AML-Patienten mit allogener/haploidenter und ohne allogene/haploidente Stammzelltransplantation war das Risiko am größten (24% bzw. 25% verglichen mit 1% bei ALL Patienten). Die Überlebensrate nach 2 Jahren betrug 50% in der Gruppe der AML-Patienten.

Schlussfolgerung:

Bei Patienten mit hohem Risiko für IA erscheint eine kontinuierliche, intravenöse antimykotische Prophylaxe essenziell und ist prospektiv in kooperativen, randomisierten Studien zu prüfen.

Key words

Aspergillosis - acute leukemia - children - fungal infection

Schlüsselwörter

Pilzinfektion - Aspergillus - Kinder - Onkologie - Leukämie - Transplantation

Full Text

References

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