Treatment of acute leukemia complicated by invasive aspergillosis in children

Abstract:

OBJECTIVE: To study the antifungal treatment and intensive chemotherapy in children with acute leukemia and invasive aspergillosis. METHODS: The diagnosis and treatment of 4 cases of childhood acute leukemia complicated by invasive aspergillosis between July 2007 and July 2008 were studied retrospectively. RESULTS: Three children who underwent remission induction chemotherapy for ALL and one who underwent consolidation chemotherapy for AML developed invasive aspergillosis. One child with proven aspergillosis and 3 with possible aspergillosis all had halo sign on CT at diagnosis. Voriconazole or amphotericin B was given as primary therapy. Improvements of fungal lesions were shown by CT after two to four weeks of antifungal therapy. Complete radiologic remissions were achieved between 4 months and one year. The intensive chemotherapy schedule was continued in all of 4 cases. The median time from fungal infection to the continuation of chemotherapy was 35 days. None showed recurrence of fungal infection. CONCLUSIONS: The halo sign on CT may be a reliable indicator for the early diagnosis of invasive aspergillosis. The preemptive antifungal therapy on the basis of the identification of a halo sign and the reversal of immunosuppression may improve the outcome of invasive aspergillosis. Prolonged antifungal treatment during subsequent cycles of chemotherapy permits completion of scheduled intensive chemotherapy without fungal recurrence.［Chin J Contemp Pediatr, 2009, 11 (11):901-904］