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An evidence-based, risk-adapted algorithm for anti-fungal prophylaxis reduces risk for invasive mold infections in children with hematologic malignancies
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  • Ashley Ikwuezunma ,
  • Ankhi Dutta,
  • Maria Castellanos,
  • Julienne Brackett,
  • Kiranmye Reddy,
  • Priya Mahajan,
  • Ann Marshburn,
  • Kala Kamdar,
  • Hana Paek,
  • Debra Palazzi,
  • Karen Rabin,
  • Michael Scheurer,
  • Maria Gramatges
Ashley Ikwuezunma
The University of Texas Rio Grande Valley School of Medicine
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Ankhi Dutta
Baylor College of Medicine Department of Pediatrics
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Maria Castellanos
Baylor College of Medicine Department of Pediatrics
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Julienne Brackett
Baylor College of Medicine Department of Pediatrics
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Kiranmye Reddy
Baylor College of Medicine Department of Pediatrics
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Priya Mahajan
Baylor College of Medicine Department of Pediatrics
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Ann Marshburn
University of Texas Health Science Center at Houston
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Kala Kamdar
Baylor College of Medicine Department of Pediatrics
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Hana Paek
Texas Children's Cancer Center and Hematology Centers
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Debra Palazzi
Baylor College of Medicine Department of Pediatrics
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Karen Rabin
Baylor College of Medicine Department of Pediatrics
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Michael Scheurer
Baylor College of Medicine Department of Pediatrics
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Maria Gramatges
Baylor College of Medicine Department of Pediatrics
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Abstract

Background: Children with hematologic malignancies, especially those who receive intensive chemotherapy, are at high risk for invasive mold infections (IMI) that confer substantial mortality. Randomized controlled trials support the use of anti-fungal prophylaxis with anti-mold activity as an optimal strategy for risk reduction in this population, but studies outlining the practical application of evidence-based recommendations are lacking. Procedure: We conducted a 15-year, single-institution retrospective review of children with hematologic malignancies treated with chemotherapy to determine the incidence of proven or probable IMI diagnosed between 2006 and 2020 and to identify the host and disease factors associated with IMI risk. We then compared the incidence and type of IMI and related factors before and after 2016 implementation of an evidence-based, risk-adapted anti-fungal prophylaxis algorithm that broadened coverage to include molds in patients at highest risk for IMI. Multivariable linear regression was used to determine factors related to IMI risk. Results: We identified 61 cases of proven or probable IMI in 1,456 patients diagnosed with hematologic malignancies during the study period (4.2%). Implementation of an anti-fungal prophylaxis algorithm reduced the IMI incidence in this population from 4.8% to 2.9%. After multivariable analysis, both Hispanic ethnicity and cancer diagnosis prior to 2016 were significantly associated with risk for IMI. Conclusion: An evidence-based, risk-adapted approach to anti-fungal prophylaxis for children with hematologic malignancies is an effective strategy to reduce incidence of IMI.

Peer review status:IN REVISION

04 May 2021Submitted to Pediatric Blood & Cancer
04 May 2021Submission Checks Completed
04 May 2021Assigned to Editor
05 May 2021Reviewer(s) Assigned
18 May 2021Review(s) Completed, Editorial Evaluation Pending
18 May 2021Editorial Decision: Revise Major
08 Jun 2021Assigned to Editor
08 Jun 20211st Revision Received
08 Jun 2021Submission Checks Completed