Epidemiology and Management Burden of Invasive Fungal Infections after Autologous Hematopoietic Stem Cell Transplantation: 10‐Year Experience at a European Pediatric Cancer Center
Christina Linke  Athanasios Tragiannidis  Martina Ahlmann  Birgit Fröhlich  Maria Wältermann  Birgit Burkhardt  Claudia Rossig  Andreas H. Groll
First published: 23 July 2019 https://doi.org/10.1111/myc.12968
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Abstract
Background
Autologous hematopoietic stem cell transplantation (HSCT) carries risks of infectious morbidity. We analyzed epidemiology and management burden associated with invasive fungal diseases (IFDs) in children and adolescents undergoing autologous HSCT.

Methods
In a retrospective, single center observational study, epidemiology and management burden associated with IFDs were analyzed in all pediatric cancer patients who underwent autologous HSCT between 2005 and 2014. Clinical, radiographic, and microbiological data were assessed up to 100 days post‐transplant. The primary endpoint was the incidence of proven, probable, and possible IFDs. Further endpoints included the use of systemic antifungal agents for prevention and management of IFDs; infectious and non‐infectious co‐morbidities; and survival until day +100.

Results
95 patients (median age: 8 years; r, 0.75‐20) underwent 103 HSCT procedures for solid tumors (92) or lymphoma (11). Primary antifungal prophylaxis was administered in 49 procedures (47.5%). No single case of proven/probable IFD was diagnosed. Nine cases (8.7%) fulfilled criteria of possible pulmonary mold infection and received treatment for a median of 14 days (r, 7‐35). In an additional 12 procedures, empiric antifungal therapy with mold active agents was given for a median of 8 days (r, 3‐105). Microbiologically documented non‐fungal infections were observed in 17 procedures, and five patients were transferred to the ICU. There was one death from biopsy documented toxic endothelial damage at day 83 post‐transplant.

Conclusions
Autologous HSCT for solid tumors or lymphoma was associated with low morbidity from IFDs. However, utilization of systemic antifungal agents for prevention and management of suspected IFDs was considerable.