619. Invasive Mold Infections (IMIs) in Pediatric Cancer Patients (pts): a Single-Institution, 10 Year Retrospective Study
Session: Abstracts: Mycology
Friday, October 22, 2010
Background: There is scarcity of data regarding opportunistic IMIs in pediatric cancer pts.

Methods: We evaluated all the pediatric pts (<18yo) who developed (probable, proven) IMIs (EORTC/MSG criteria), being diagnosed at our institution over a 10 year period (1998-2008). We retrospectively reviewed the demographic data, risk factors, clinical picture and management of IMI. We assessed crude mortality, complete and partial response at 12 weeks following diagnosis

Results: 48 such pts were identified (30; 63% proven and 18; 37% probable IMI). Out of 35 isolated molds, the most prevalent were Aspergillus spp (14; 40%), Mucorales spp (7; 20%) and Fusarium spp (4; 11%). 44% of the IMI were breakthrough infections. Acute leukemias (39; 81%), active status of malignancy (25; 52%), neutropenia (32; 67%) (<500mm3) and HSCT (20; 42%) were commonly identified. Additionally, high corticosteroid treatment (≥ 600 mg of a prednisone equivalent during the month prior to the diagnosis) (17; 35%), chemotherapeutics (41; 85%) and immunosuppressives (17; 35%) during the previous 2 months further predisposed pediatric pts to IMI. Lungs (77%), skin (29%) and sinonasal (19%) were the most common sites of infection. Therapeutic antifungal regiments combined with growth factors G/GM-CSF (31; 65%) and surgery (18; 38%) resulted in a 33% (16/48) complete and 21% (10/48) partial 12 week response. Crude mortality was 6/48 (12.5%) at 4 weeks and 35% (15/48) at 12 weeks. Female gender (P=0.05) and monocytopenia (P=0.01) were identified by logistic regression as independent risk factors for mortality at 4 weeks.

Conclusion: IMIs in pediatric cancer pts is typically seen in the setting of acute uncontrolled leukemia or HSCT and are associated with significant mortality. Over 60% of the isolated IMIs are due to non-Aspergillus molds. Invasive skin infections are relatively common.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
Georgios Pongas, MD , Infectious Diseases, MD Anderson Cancer Ctr, Houston, TX
Russell Lewis, PharmD , University of Houston College of Pharmacy, Houston, TX
Dimitrios Kontoyiannis, MD, FIDSA , MD Anderson Cancer Ctr, Houston, TX

Disclosures:

G. Pongas, None

R. Lewis, Yes
Merck & Co: --, Grant Investigator and Speaker's Bureau, Grant recipient
Astellas: --, Consultant and Grant Investigator, Grant recipient

D. Kontoyiannis, Yes
Enzon: Grant Investigator, Speaker's Bureau and research grants,
Astellas: Grant Investigator, Speaker's Bureau and research grant,
Merck: Consultant, Consultant and Speaker's Bureau,
Pfizer: Speaker's Bureau,
Schering-Plough: Consultant and Consultant,

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