Five-year-survey of invasive aspergillosis in a paediatric cancer centre. Epidemiology, management and long-term survival

The epidemiology, management, and long-term survival of invasive aspergillo sis was assessed in a prospective, 5-year observational study in 346 unsele cted paediatric cancer patients receiving dose-intensive chemotherapy for n ewly diagnosed or recurrent malignancies. Invasive aspergillosis occurred e xclusively in the context of haematological malignancies, where it accounte d for an incidence of 6.8% (n = 13 of 189). The lung was the primary site i n 12 cases, and dissemination was present in three of those. Prior to diagn osis, the overwhelming majority of patients had been profoundly neutropenic for at least 14 days (n= 11 of 13) and were receiving systemic antifungal agents (n = 10 of 13). Clinical signs and symptoms were nonspecific but alw ays included fever. All 11 patients who were diagnosed and treated during l ifetime for a minimum of 10 days responded to either medical or combined me dical and surgical treatment, and seven were cured (64%). Nevertheless, the overall long-term survival was merely 31% after a median follow-up of 5.68 years after diagnosis. Apart from refractory or recurrent cancer, the main obstacles to successful outcome were failure to diagnose IA during lifetim e and bleeding complications in patients with established diagnosis. The fr equency of invasive aspergillosis of greater than 15% in paediatric patient s with acute myeloblastic leukaemia and recurrent leukaemias warrants the s ystematic investigation of preventive strategies in these highly vulnerable subgroups.