Introduction Leukaemia is the most common cancer in children accounting for around a third of all cases and acute lymphoblastic leukaemia (ALL) is the most common of all leukaemias.¹ The intense induction treatment for ALL results in patients becoming immunocompromised and susceptible to infections.

It was noticed that many patients undergoing ALL induction required antifungal treatment courses when attending outpatient clinic. It is not standard practice to give patients upfront antifungal prophylaxis in ALL treatment.

Aim The aim of this audit was to identify the number of patients undergoing induction phase of ALL treatment who end up developing a fungal infection and require treatment. To identify whether it would be necessary for patients undergoing ALL treatment to receive antifungal prophylaxis.

Method A list of all patients treated for induction ALL was collected between 1/9/21–1/9/22. Data was collected retrospectively by looking through each patient’s medical notes to identify whether they developed a fungal infection during or 1 week after completing their induction.

Results and Discussion 59 out of the 99 patients audited (n=58%) developed a fungal infection. 42 patients were prescribed antifungals when attending the outpatient clinic and their treatment was managed at home. The remaining 14 patients required antifungal treatment at their tertiary hospital (n=12) or at their local hospital (n=2). Oral thrush was the most common infection developed during induction accounting for 40% of infections and nappy rash was the second most common infection developed during induction accounting for 46% of infection cases. 72% of patients only required 1 course, 21% needed 2 courses and 7% required 7 courses of antifungals to treat the same infection. Treatment agents varied for each indication and duration of treatment varied substantially ranging from 7 days to 28 days. 23% of patients audited who developed a fungal infection developed two separate infections during induction. Infection rates for patients treated under regimen A were similar to regimen B (58% and 60% respectively).

Conclusion The results demonstrate that over 50% of patients treated for ALL develop a fungal infection during their induction. It is important to note that adequate treatment is required, 26% (15/57) of patients treated with an antifungal required more than one course to treat the same infection during induction. Most prescriptions requiring additional treatment were initially prescribed for 7 days. It is clear from this audit that the prescribing of antifungals is not standardised. An introduction of antifungal prophylaxis for patients undergoing ALL treatment induction might bring the infection rate down. An audit should be conducted to compare the infection rates of patients treated for infant ALL whilst receiving antifungal cover compared to children>1 years old treated for ALL who do not receive antifungal cover.

Reference

1. Childhood acute lymphoblastic leukemia treatment [Internet]. 2022 https://www.cancer.gov/types/leukemia/patient/child-all-treatment-pdq (Accessed 10 July 2023).