Invasive Fusariosis in Pediatric Hematology/Oncology and Stem Cell Transplant Patients: A Report from the Israeli Society of Pediatric Hematology-Oncology

Marganit Benish, Sarah Elitzur*, Nira Arad-Cohen, Assaf Arie Barg, Miriam Ben-Harosh, Bella Bielorai, Salvador Fischer, Gil Gilad, Itzhak Levy, Hila Rosenfeld-Keidar, Yael Shachor-Meyouhas, Galia Soen-Grisaru, Sigal Weinreb, Ronit Nirel, Ronit Elhasid

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Invasive Fusarium species infections in immunocompromised patients occur predominantly in those with hematological malignancies. Survival rates of 20–40% were reported in adults, but data in children are limited. Our retrospective, nationwide multicenter study of invasive fusariosis in pediatric hematology/oncology and stem cell transplant (SCT) patients identified twenty-two cases. Underlying conditions included hematological malignancies (n = 16; 73%), solid tumors (n = 2), and non-malignant hematological conditions (n = 4). Nineteen patients (86%) were neutropenic, nine (41%) were SCT recipients, and seven (32%) received corticosteroids. Sixteen patients (73%) had disseminated fusariosis, five had local infection, and one had isolated fungemia. Fifteen patients (68%) had skin involvement and eight (36%) had a bloodstream infection. Four patients (18%) presented with osteoarticular involvement and four with pulmonary involvement. Nineteen patients (86%) received combination antifungal therapy upfront and three (14%) received single-agent treatment. Ninety-day probability of survival was 77%: four of the five deaths were attributed to fusariosis, all in patients with relapsed/refractory acute leukemias. Ninety-day probability of survival for patients with relapsed/refractory underlying malignancy was 33% vs. 94% in others (p < 0.001). Survival rates in this largest pediatric population-based study were strikingly higher than those reported in adults, demonstrating that invasive fusariosis is a life-threatening but salvageable condition in immunosuppressed children.

Original languageEnglish
Article number387
JournalJournal of Fungi
Volume8
Issue number4
DOIs
StatePublished - Apr 2022

Keywords

  • cancer
  • children
  • fusarium
  • immunocompromised
  • invasive fungal infections
  • leukemia
  • pediatric hematology oncology
  • stem cell transplantation

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