Methods
We analyzed a retrospective cohort of patients who were treated at our
institution, the Institute of Pediatric Oncology - Support Group for
Adolescents and Children with Cancer/Federal University of Sao Paulo
(IOP-GRAACC/UNIFESP), from January 1, 2011 to December 31, 2019.
Patients aged 0 to 18 years, diagnosed with cancer, submitted or not to
hematopoietic stem cell transplantation, were included. We analyzed only
patients who had proven or probable invasive fungal infection, as
defined by the consensus from the European Organization for Research and
Treatment of Cancer and the Mycoses Study Group Education and Research
Consortium.4 The study was approved by the Ethics and
Research Committee of the Federal University of São Paulo.
Variables collected included the subject’s demographic characteristics,
underlying disease, type and site of IFD, antifungals drugs, and
outcomes. Death was considered as resulting from the fungal infection
when it occurred because of clinical deterioration with evidence of a
proven or probable IFD.
For survival analyses, we used the Weibull distribution to parameterize
hazard ratios and accelerated failure time models (AFT). An AFT model
assumes that the effect of a covariate is to accelerate or decelerate
the life course of a disease by some constant.5Conditions like the diagnoses, relapse of disease, hematopoietic stem
cell transplant, use of antifungal drugs at the time of diagnosis of
IFD, presence of neutropenia, age, and site of infection were tested in
models for the outcome “death caused by IFD”. Kaplan Meier curves were
also made for this outcome, with comparisons using the Log Rank test
(Mantel-Cox). All the statistical tests were performed with R software,
version 4.0.2 (The R Foundation for Statistical Computing, 2020).