Thesis (Ph.D.) - Cairo University - National Cancer Institute - Department of Pediatric Oncology

Patients with hematologic malignancies are at higher risk for invasive fungal infections (IFI) caused by molds than by yeasts, and the incidence of IFI is highest among patients with acute myeloid leukemia. Early detection and may be appropriate antifungal prophylaxis can help to decrease incidence of these infections and its related complications. Patients and methods: A double-arms retrospective and prospective study included 136 newly diagnosed Acute Myeloid Leukemia patients treated at the National Cancer Institute, Cairo university from 2011 to 2013. Prospective group (Group B) received primary Voriconazole and levofloxacin prophylaxis and compared to retrospective control regarding the infectious complications and incidence of fungal infection. Results: Median age was 5 - 6 years. Most patients were males, living in Giza and Cairo. Most patients were standard risk. Age, Gender, initial TLC, initial Monocytic Count, Risk stratifications and previous Hospitalization, were comparable between both groups. Younger age, initial free CT chest and early entry into marrow remission were associated with decreased IFI, while no effect of TLC, Monocytic count and previous Hospitalization. Voriconazole decreased IFI in prospective group significantly. Almost all primary fungal infections occurred in lungs. Most of IFI occurred during induction phase of chemotherapy. Overall survival and Event free survival were comparable between both groups. Three years OS was 38% retrospective and 36% prospective. EFS was 36.6% in pre prophylaxis group compared to 32.5% in prophylaxis group. This is due to high relapses and mortalities. Voriconazole had an accepted toxicity profile

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