title: Invasive aspergillosis in children with acute leukemia at a resource-limited oncology center.
abstract: BACKGROUND
  Invasive aspergillosis (IA) is one of the most feared complications in patients with hematologic malignancies because it is associated with high morbidity and mortality, and significantly compromises antileukemia therapy.
  
  
  OBJECTIVE
  Analyze all patients with acute leukemia and IA of less than 18 years of age, diagnosed between January 1996 and December 2011.
  
  
  METHODS
  Cases were identified from the pediatric database for demographic details, disease characteristics, and IA-related data.
  
  
  RESULTS
  Among 356 patients with acute leukemia, 34 were identified to have proven/probable IA (5/29) with a relative incidence of 9% (28/310) and 13% (6/46) among acute lymphoblastic leukemia (ALL) and acute myeloid leukemia, respectively. Incidence of IA was significantly higher after 2004 especially among ALL patients; older patients with hyperglycemia and high-risk disease were more predisposed. None of the risk factors or type of antifungal treatment predicted mortality. The 120-day aspergillus-attributable mortality rate was 14.7%. IA led to a median of 17 days (2 to 44 d) of additional hospital stay and contributed to delay or reduction in planned chemotherapy in 30/34 patients.
  
  
  CONCLUSIONS
  An increasing trend in incidence of IA was observed during the latter half of study period. Early empiric therapy led to modest aspergillus-free survival. Clinical and financial implications of IA mandate review of institutional antifungal prophylaxis policy especially in selected ALL patients during induction.
authors.affiliation: Department of Pediatric Hematology and Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Jain
authors.forename: Gauri
authors.initials: G
authors.lastname: Kapoor
mesh_terms: D000293:Adolescent; D001228:Aspergillosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006295:Health Resources; D006801:Humans; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*