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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

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

Bibliographical note

Funding Information:
This work was supported by the Israeli Society of Pediatric Haematology‐Oncology, the Israel Cancer Association and Amutat Chaim. The authors thank Dina Kugel for the diligent data collection, Reut Rosen (Hebrew University) for the statistical analysis and Gloria Ganzach for the careful editing. We extend our thanks to Dr. Batia Stark for leading the Israeli Study Group of Childhood Leukemia for many years. We wish to acknowledge all paediatric haematology/oncology departments in Israel for their devoted care of these challenging patients and the multidisciplinary teams who came to our assistance.

Funding Information:
This work was supported by the Israeli Society of Pediatric Haematology-Oncology, the Israel Cancer Association and Amutat Chaim. The authors thank Dina Kugel for the diligent data collection, Reut Rosen (Hebrew University) for the statistical analysis and Gloria Ganzach for the careful editing. We extend our thanks to Dr. Batia Stark for leading the Israeli Study Group of Childhood Leukemia for many years. We wish to acknowledge all paediatric haematology/oncology departments in Israel for their devoted care of these challenging patients and the multidisciplinary teams who came to our assistance.

Publisher Copyright:
© 2019 British Society for Haematology and John Wiley & Sons Ltd

Keywords

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

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