Prolonged survival after invasive aspergillosis: a single-institution review of 11 cases.
OBJECTIVE
To perform a retrospective review of the authors' experience with invasive aspergillosis (IA) in a pediatric population treated with conventional chemotherapy. Case series of IA in the pediatric oncology population are limited but generally report poor overall survival.


METHODS
Medical records were reviewed of all patients receiving conventional chemotherapy for malignant disease who developed IA at Children's Hospital and Regional Medical Center, Seattle, Washington, between January 1, 1995, and January 1, 2002.


RESULTS
During the study period there were 11 cases of IA in pediatric cancer patients treated with conventional chemotherapy. All patients had pulmonary IA; two also had evidence of disseminated disease. All patients underwent diagnostic tissue biopsy. Sixty-four percent required further surgery to excise bulky disease. Medical therapy varied with disease presentation and the overall clinical picture, although prolonged treatment with amphotericin B and itraconazole was the mainstay of therapy. Resolution of clinical disease was seen in 91% of patients. Seventy-three percent received further chemotherapy. The 3-year estimated survival was 82%, with a median follow-up of 32.5 months.


CONCLUSIONS
Early diagnosis and aggressive intervention improve long-term survival from IA in immunocompromised pediatric oncology patients. Aggressive surgical resection, prolonged medical therapy after gross resolution of disease, and chemoprophylaxis during subsequent chemotherapy decrease the likelihood of recurrent IA despite subsequent cytotoxic therapy. The ability to proceed with intensive chemotherapy despite a history of IA may improve long-term survival.
Wright
Jessica A
JA
Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington 98105-0371, USA. jawright@u.washington.edu
Bradfield
Scott M
SM
Park
Julie R
JR
Hawkins
Douglas S
DS
D000293:Adolescent; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007938:Leukemia / Q000150:complications / Q000188:drug therapy; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D008297:Male; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000188:drug therapy; D009503:Neutropenia / Q000150:complications; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors
D000890:Anti-Infective Agents; D000935:Antifungal Agents