An evidence-based, risk-adapted algorithm for anti-fungal prophylaxis
reduces risk for invasive mold infections in children with hematologic
malignancies
Abstract
Background: Children with hematologic malignancies, especially those who
receive intensive chemotherapy, are at high risk for invasive mold
infections (IMI) that confer substantial mortality. Randomized
controlled trials support the use of anti-fungal prophylaxis with
anti-mold activity as an optimal strategy for risk reduction in this
population, but studies outlining the practical application of
evidence-based recommendations are lacking. Procedure: We conducted a
15-year, single-institution retrospective review of children with
hematologic malignancies treated with chemotherapy to determine the
incidence of proven or probable IMI diagnosed between 2006 and 2020 and
to identify the host and disease factors associated with IMI risk. We
then compared the incidence and type of IMI and related factors before
and after 2016 implementation of an evidence-based, risk-adapted
anti-fungal prophylaxis algorithm that broadened coverage to include
molds in patients at highest risk for IMI. Multivariable linear
regression was used to determine factors related to IMI risk. Results:
We identified 61 cases of proven or probable IMI in 1,456 patients
diagnosed with hematologic malignancies during the study period (4.2%).
Implementation of an anti-fungal prophylaxis algorithm reduced the IMI
incidence in this population from 4.8% to 2.9%. After multivariable
analysis, both Hispanic ethnicity and cancer diagnosis prior to 2016
were significantly associated with risk for IMI. Conclusion: An
evidence-based, risk-adapted approach to anti-fungal prophylaxis for
children with hematologic malignancies is an effective strategy to
reduce incidence of IMI.