Treatment of Invasive Fungal Disease During Therapy for Acute Lymphoblastic Leukemia
Bibliographic record
Abstract
Invasive fungal diseases (IFDs) are one of the leading causes of death in acute leukemia (AL) patients. Because of the possibility of fungal relapse, patients who survive IFDs may have difficulty in completing the whole chemotherapy plan. Our case report presents two cases of IFD with aspergillosis in children with precursor B-cell acute lymphoblastic leukemia (pre-B-ALL). Two 9-year-old female patients were diagnosed with pre-B-ALL that were on the pre-B-ALL protocol: CALL08, Arm-C (high-risk arm), and the supportive therapy. They were both on Arm-C of the CALL08 protocol (high risk based on COG232). Then, the patients experienced severe febrile neutropenia. Patient 1 was during consolidation, and patient 2 was during interim maintenance I. Both experienced prolonged febrile neutropenia. As febrile neutropenia continued for more than 5 days, a fungal workup was conducted, including computed tomography (CT) scans of the sinuses, chest, and abdomen, as well as serum tests for galactomannan and (1→3)-β-D-glucan (BDG). Caspofungin treatment was started. Fungal workup results showed lung and liver nodules in one patient and lungs, liver, and spleen in the other. There were about 4 weeks of severe fevers and neutropenia, despite the use of broad-spectrum antibiotics. A decision was taken to interrupt chemotherapy for both patients. Voriconazole was added to caspofungin. Biopsies confirmed the diagnosis to be severe fungal infection with invasive aspergillosis. After that, high fevers and neutropenia slowly recovered, and a repeated CT scan of abdomen showed good improvement in the lesion's number and size. After 6 - 8 weeks of interruption, chemotherapy was resumed. We observed that with the implementation of combination antifungal therapy with voriconazole and caspofungin for 6 weeks and then single antifungal therapy (voriconazole orally) for another 6 weeks, both patients recovered and became clinically stable and afebrile. Chemotherapy was on hold till they became better. In conclusion, primary and secondary antifungal prophylaxis are recommended for ALL patients. Chemotherapy discontinuation is decided on an individual basis according to the severity of the fungal infection and disease status.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".