Mucormycosis in children with haematological malignancies is a salvageable disease: a report from the Israeli Study Group of Childhood Leukemia

Sarah Elitzur, Nira Arad-Cohen, Assaf Barg, Naomi Litichever, Bella Bielorai, Ronit Elhasid, Salvador Fischer, Yariv Fruchtman, Gil Gilad, Joseph Kapelushnik, Mira Kharit, Osnat Konen, Ruth Laor, Itzhak Levy, Dror Raviv, Yael Shachor-Meyouhas, Yulia Shvartser-Beryozkin, Amos Toren, Isaac Yaniv, Ronit NirelShai Izraeli, Shlomit Barzilai-Birenboim

Research output: Contribution to journalArticlepeer-review

Abstract

Mucormycosis has emerged as an increasingly important cause of morbidity and mortality in immunocompromised patients, but contemporary data in children are lacking. We conducted a nationwide multicentre study to investigate the characteristics of mucormycosis in children with haematological malignancies. The cohort included 39 children with mucormycosis: 25 of 1136 children (incidence 2·2%) with acute leukaemias prospectively enrolled in a centralized clinical registry in 2004–2017, and an additional 14 children with haematological malignancies identified by retrospective search of the databases of seven paediatric haematology centres. Ninety-two percent of mucormycosis cases occurred in patients with acute leukaemias. Mucormycosis was significantly associated with high-risk acute lymphoblastic leukaemia (OR 3·75; 95% CI 1·51–9·37; P = 0·004) and with increasing age (OR 3·58; 95% CI 1·24–9·77; P = 0·01). Fifteen patients (38%) died of mucormycosis. Rhinocerebral pattern was independently associated with improved 12-week survival (OR 9·43; 95% CI 1·47–60·66; P = 0·02) and relapsed underlying malignancy was associated with increased 12-week mortality (OR 6·42; 95% CI, 1·01–40·94; P = 0·05). In patients receiving frontline therapy for their malignancy (n = 24), one-year cumulative mucormycosis-related mortality was 21 ± 8% and five-year overall survival was 70 ± 8%. This largest paediatric population-based study of mucormycosis demonstrates that children receiving frontline therapy for their haematological malignancy are often salvageable.

Original languageEnglish
Pages (from-to)339-350
Number of pages12
JournalBritish Journal of Haematology
Volume189
Issue number2
DOIs
StatePublished - 1 Apr 2020

Keywords

  • children
  • fungal infections
  • hematological malignancies
  • leukemia
  • mucormycosis

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