Materials and Methods
A retrospective study was conducted at ’Health Science University Ankara Children’s Hematology Oncology Training and Research Hospital’ from January 2014 until December 2017. Patients under 18 years of age with a hematological malignancy (acute lymphoblastic or myeloblastic leukemia) diagnosed as IFI were enrolled. Basic demographic data, underlying conditions, neutropenia (absolute neutrophil count <500 cells/μL) durations, radiological findings, antifungal medications and side effects, and outcomes were noted. Galactomannan (GM) enzyme immunoassay (Platelia Aspergillus, BioRad, France) analysis in plasma were obtained in the presence neutropenic fever and IFI episode twice weekly, and ≥0.5 were considered positive. All patients received prophylactic antifungal agents according to their primary disease protocol, and the risk or history of IFI. Diagnosis of IFI was defined acording to the criteria of the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Disease Mycoses Study Group (EORTC/MSG).16 Patients were grouped according to a diagnosis of proven, probable, or possible IFI. Empirical antifungal treatment was initiated if fever persisted for more than 96 hours after initiation of empiric antibacterial treatment considering guidelines.17,18 If there were symptoms, signs, laboratory or radiological findings suggestive of invasive fungal infection, antifungal therapy was initiated earlier than the above-mentioned period. CAT was initiated based on the patient’s IFI condition and clinician’s subjective decision. The day of diagnosis was defined as the day that the clinician confirmed diagnosis of IFI, and onset the antifungal treatment. Response to treatment was defined according to criteria of EORTC/MSG.16 Overall response rate and overall survival rate based on 12 weeks were recorded. Research ethics board approval was obtained for the study from the local ethics committee of institution.
Statistical analysis was performed using SPSS v25.0 (IBM Corp., Armonk, New York, USA) statistical package. Categorical variables were compared by chi-square or Fisher exact tests, and were summarized with frequencies. For continuous variables, median and interquartile range (IQR) were calculated. Group comparisons were carried out using independent samples t-test or Mann–Whitney U-tests, and Kruskal-Wallis test if appropriate. All tests were 2-sided with a significance level of 0.05.