Abstract
Background: Invasive fungal diseases (IFD) are important causes of
mortality in children with cancer. We aimed to determine the extent of
survival in patients treated for IFD in the last nine years at our
center. Procedure: a retrospective cohort of patients treated from
January 1, 2011 to December 31, 2019. Weibull distribution was used to
parameterize hazard ratios and accelerated failure time models, for the
outcome “death attributed to IFD”. Results: We analyzed 152 patients
with IFD (133 proven and 19 probable), with median age of 97 months. The
most frequent diagnoses were leukemia (39, 25.7%) and central nervous
system tumors (36, 23.7%). Thirty-seven patients received prophylaxis
with fluconazole (24.3%). There were 133 fungi isolates, and most
frequent were Candida species in blood (84, 55.2%). Forty-three deaths
were attributed to IFD (28.3%). Survival probabilities were lower for
pulmonary IFD (46.9%, p = 0.0017), leukemia (62.5%, p = 0.004), and
neutropenia <500 cells/mm3 (55.4%, p < 0.0001). For
Candida fungemia, survival probabilities were 76.6% (p = 0.043). In
Weibull models, diagnosis of leukemia shortened survival times by a
factor of 0.006, relapse of disease by 0.05, lymphoma by 0.04, pulmonary
IFD by 0.04, and neutropenia by 0.015. Hematopoietic stem cell
transplantation did not affect the survival times, as well as
prophylaxis with fluconazole. Conclusions: Host factors, like
neutropenia, relapse of disease and hematologic malignancies, are
determinant in the survival times of children with IFD, as well as
pulmonary involvement. Fluconazole prophylaxis and HSCT do not affect
the hazards of death.