Outcomes of invasive fungal infections in 358 children undergoing allogeneic haematopoietic stem cell transplantation: A prospective UK study
The optimal strategy to prevent and treat invasive fungal infections (IFIs) in children receiving allogeneic haematopoietic stem cell transplantation (HSCT) is not well established. A paediatric bone marrow transplant (BMT) working group set up UK national guidelines for the management of IFI and conducted a prospective study to assess the impact of these on incidence and outcomes. From March 2017 to December 2021, 358 children who received HSCT were prospectively included. Most children (82%) received either itraconazole (41%) or liposomal amphotericin B (41%) prophylaxis with a median duration of 170 days (interquartile range [IQR] 101-279). Cumulative incidence of possible/probable/proven IFI at 1 year was 17.6%, with no significant differences in children receiving itraconazole or liposomal amphotericin B (15.7% vs. 15.9%, 0.997). In multivariate analysis models (Fine-Gray hazard ratio) underlying malignant disease and low azoles therapeutic drug monitoring levels were independently associated with development of IFI. Children with probable/proven IFI had a higher 1-year transplant-related mortality (22% vs. 5.7%, Gray's test, p < 0.001). By adopting standardized anti-fungal prophylaxis, the incidence of proven/probable IFI in a large cohort of transplanted children was 5% and these showed significant decreased survival, warranting tailored prophylactic strategies in high-risk patients.
Authors
- Caroline Furness
- Bilyana Doncheva
- Arina Lazareva (ORCID: https://orcid.org/0000-0002-8902-9146)
- Emanuele Lanino (ORCID: https://orcid.org/0009-0000-0676-0201)
- Zohreh Nademi (ORCID: https://orcid.org/0000-0002-3874-2646)
- Madeleine Powys (ORCID: https://orcid.org/0000-0002-2458-3111)
- Giorgio Ottaviano (ORCID: https://orcid.org/0000-0003-3777-0394)
- Beki James (ORCID: https://orcid.org/0000-0002-0558-8638)
- Persis Amrolia (ORCID: https://orcid.org/0000-0003-0480-3911)
- Adam Irwin (ORCID: https://orcid.org/0000-0001-8974-6789)
- Robert Chiesa (ORCID: https://orcid.org/0000-0001-9323-0259)
- Juliana Silva
- Kanchan Rao (ORCID: https://orcid.org/0000-0001-9449-8476)
- Sarah Lawson
- Joseph Frank Standing
- Katharine Patrick
- Adilia Warris
- Olga Tatarinova
- Anoop Cherungonath
Institutions
- Royal Marsden NHS Foundation Trust (GB)
- The University of Queensland (AU)
- University of Exeter (GB)
- Leeds Teaching Hospitals NHS Trust (GB)
- Great Ormond Street Hospital (GB)
- Great Ormond Street Hospital for Children NHS Foundation Trust (GB)
- Royal Victoria Infirmary (GB)
- Birmingham Children's Hospital (GB)
- Azienda Ospedaliera San Gerardo (IT)
- Royal Marsden Hospital (GB)
- Sheffield Children's NHS Foundation Trust (GB)
- Great North Children's Hospital (GB)
- Oxford University Hospitals NHS Trust (GB)
- Royal Manchester Children's Hospital (GB)
- Institute of Infection and Immunity (CA)
- Children's Health Queensland Hospital and Health Service (AU)
- University College London (GB)
Publication Details
- Journal
- British Journal of Haematology
- Published
- 2026-06-30
- DOI
- https://doi.org/10.1111/bjh.70628
- Primary Topic
- Antifungal resistance and susceptibility
- Type
- article
- Field-Weighted Citation Impact
- 0.00