Approaches to Invasive Fungal Diseases in Paediatric Cancer Centres: An Analysis of Current Practices and Challenges in Germany, Austria and Switzerland

Danila Seidel^{1

2}, Zoi Dorothea Pana³, Daniel Ebrahimi-Fakhari⁴, Sarina K Butzer^{5

6}, Katrin Mehler⁵, Ilana Reinhold^{1

2}, Arne Simon⁷, Christian Dohna-Schwake⁸, Ines Mack⁹, Nicole Bodmer¹⁰, Tim Niehues¹¹, Alexander Claviez^{12

13}, Alfred Längler¹⁴, Alfred Leipold¹⁵, Aram Prokop¹⁶, Bastian Brummel¹⁷, Beate Winkler¹⁸, Bernd Gruhn¹⁹, Carl Friedrich Classen²⁰, Carsten Friedrich²¹, Christa Koenig²², Christian Flotho²³, Fiona Poyer²⁴, Freimut Schilling²⁵, Gabriele Calaminus²⁶, Geeke Sieben²⁷, Georg C Schwabe²⁸, Harald Reinhard²⁹, Heiko-Manuel Teltschik³⁰, Heinz Hengartner³¹, Jana Stursberg³², Jeanette Greiner³³, Johann Greil³⁴, Jörg Leyh³⁵, Jörn-Sven Kühl³⁶, Karoline Ehlert³⁷, Konrad Bochennek³⁸, Marius Rohde³⁹, Martin Demmert⁴⁰, Martina Stiefel⁴¹, Matthias Eyrich⁴², Meinolf Siepermann⁴³, Michael Frühwald⁴⁴, Michaela Döring⁴⁵, Michaela Nathrath^{46

47}, Milen Minkov⁴⁸, Monika Streiter⁴⁹, Neil Jones⁵⁰, Nora Naumann-Bartsch⁵¹, Norbert Jorch⁵², Olaf Beck⁵³, Rita Beier⁵⁴, Roman Crazzolara⁵⁵, Silke Kietz⁵⁶, Simon Vieth⁵⁷, Stefan Fröhling⁵⁸, Stephan Lobitz⁵⁹, Sujal Ghosh⁶⁰, Tanja C Vallée⁶¹, Thilo Müller⁶², Thomas Wiesel⁶³, Tobias Däbritz⁶⁴, Udo Kontny⁶⁵, Uwe Thiel⁴⁹, Volker Strenger⁶⁶, Wolfgang R Eberl⁶⁷, Oliver A Cornely^{1

68

69

70}, Andreas H Groll⁴, Thomas Lehrnbecher³⁸

Affiliations

¹ Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
² Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
³ Medical School, University of Nicosia (UNIC), Nicosia, Cyprus.
⁴ Infectious Disease Research Program, Center for Bone Marrow Transplantation and Dept. of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany.
⁵ Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
⁶ Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
⁷ Department of Pediatric Hematology and Oncology, University Medical Center of Saarland, Homburg/Saar, Germany.
⁸ Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
⁹ Department of Paediatric Infectious Diseases and Vaccinology, University Children's Hospital Basel (UKBB) and University of Basel, Basel, Switzerland.
¹⁰ Department of Oncology, University Children's Hospital Zurich, Zurich, Switzerland.
¹¹ Centre for Child and Adolescent Health, Helios Klinikum Krefeld, Germany.
¹² Department of Pediatrics, University Hospital Magdeburg, Magdeburg, Germany.
¹³ Clinic for Pediatric Oncology and Hematology, Hannover Medical School, Hannover, Germany.
¹⁴ Department of Paediatrics and Adolescent Medicine, Community Hospital Herdecke, Herdecke, Germany.
¹⁵ Children's Hospital Karlsruhe, Karlsruhe, Germany.
¹⁶ Campus University Medical School Hamburg (MSH), Helios Clinic Schwerin, Schwerin, Germany.
¹⁷ Department of Pediatric Oncology and Hematology, Klinikum Dortmund, Dortmund, Germany.
¹⁸ Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁹ Department of Pediatrics, Jena University Hospital, Jena, Germany.
²⁰ Section of Pediatric Oncology and Palliative Medicine, Klinik für Kinder- und Jugendmedizin, Universitätsmedizin Rostock, Rostock, Germany.
²¹ Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky Universität Oldenburg, Klinikum Oldenburg AöR, Oldenburg, Germany.
²² Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
²³ Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany.
²⁴ Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria.
²⁵ Pediatric Oncology-Hematology, Children's Hospital of Central Switzerland, Lucerne, Switzerland.
²⁶ Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany.
²⁷ Pediatric Oncology and Hematology, University Medical Center Mannheim, Mannheim, Germany.
²⁸ Children's Hospital, Medical University Lausitz-Carl Thiem, Cottbus, Germany.
²⁹ Department of Pediatrics, Asklepios Children's Hospital, Sankt Augustin, Germany.
³⁰ Department of Hematology and Oncology, Children's Hospital Stuttgart-Olgahospital, Stuttgart, Germany.
³¹ Pediatric Hospital of Eastern Switzerland St Gallen, St Gallen, Switzerland.
³² Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany.
³³ Pediatric Oncology-Hematology, Children's Hopital, Cantonal Hospital Aarau, Aarau, Switzerland.
³⁴ Department of Pediatric Hematology, Oncology and Immunology, University Hospital Heidelberg, Heidelberg, Germany.
³⁵ Department of Pediatric Hematology and Oncology, Klinik Hallerwiese-Cnopfsche Kinderklinik, Nürnberg, Germany.
³⁶ Department of Pediatric Oncology, Hematology and Hemostaseology, University of Leipzig, Leipzig, Germany.
³⁷ Department of Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, Germany.
³⁸ Department of Pediatrics, Division of Hematology, Oncology and Hemostaseology, Goethe University Frankfurt, Frankfurt/Main, Germany, Frankfurt am Main, Germany.
³⁹ Pediatric Hematology and Oncology, University Hospital Giessen, Giessen, Germany.
⁴⁰ Clinic for Pediatric and Adolescent Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany.
⁴¹ Department of Pediatrics, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
⁴² Department of Pediatric Haematology, Oncology and Stem Cell Transplantation, University Medical Center, University Children's Hospital, University of Würzburg, Würzburg, Germany.
⁴³ Clinic for Children and Youth Medicine, Department for Pediatric Hematology/Oncology, Children's Hospital Amsterdamer Straße, Cologne, Germany.
⁴⁴ Swabian Children's Cancer Center, Pediatrics and Adolescent Medicine, University Medical Center Augsburg, Augsburg, Germany.
⁴⁵ Department of Paediatric Haematology/Oncology, Children's University Hospital, Tübingen, Germany.
⁴⁶ Department of Pediatrics and Children's Cancer Research Center, School of Medicine, Technical University of Munich, Munich, Germany.
⁴⁷ Pediatric Hematology and Oncology, Klinikum Kassel, Kassel, Germany.
⁴⁸ Division of Pediatric Oncology, Department of Pediatrics and Adolescent Medicine, Johannes Kepler University, Linz, Austria.
⁴⁹ Clinic for Pediatrics and Adolescent Medicine, Hematology/Oncology, Klinikum am Gesundbrunnen Heilbronn, Heilbronn, Germany.
⁵⁰ Department of Pediatrics and Adolescent Medicine University Clinics, Salzburg, Austria.
⁵¹ Department for Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany.
⁵² University Children's Hospital, Evangelisches Klinikum Bethel, Bielefeld, Germany.
⁵³ Department of Pediatric Hematology/Oncology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
⁵⁴ Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany.
⁵⁵ Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria.
⁵⁶ Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg, Regensburg, Germany.
⁵⁷ Department of Pediatrics, University Hospital Schleswig-Holstein, Kiel, Germany.
⁵⁸ Pediatric Oncology Center, Bremen-Mitte, Professor Hess Children's Hospital, Bremen, Germany.
⁵⁹ Pediatric Hematology & Oncology, Gemeinschaftsklinikum Mittelrhein, Koblenz, Germany.
⁶⁰ Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.
⁶¹ Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany.
⁶² Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
⁶³ Children's Hospital, Vestische Youth Hospital, University of Witten/Herdecke, Datteln, Germany.
⁶⁴ Department of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
⁶⁵ Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Hospital Aachen, Aachen, Germany.
⁶⁶ Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
⁶⁷ Department of Hematology and Oncology, Center for Child and Adolescent Medicine, Städtisches Klinikum Braunschweig gGmbH, Braunschweig, Germany.
⁶⁸ Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
⁶⁹ German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
⁷⁰ Clinical Trials Centre Cologne (ZKS Köln), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.

PMID: 40515497
PMCID: PMC12166348
DOI: 10.1111/myc.70074

Approaches to Invasive Fungal Diseases in Paediatric Cancer Centres: An Analysis of Current Practices and Challenges in Germany, Austria and Switzerland

Danila Seidel et al. Mycoses. 2025 Jun.

. 2025 Jun;68(6):e70074.

doi: 10.1111/myc.70074.

Authors

Affiliations

¹ Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
² Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
³ Medical School, University of Nicosia (UNIC), Nicosia, Cyprus.
⁴ Infectious Disease Research Program, Center for Bone Marrow Transplantation and Dept. of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany.
⁵ Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
⁶ Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
⁷ Department of Pediatric Hematology and Oncology, University Medical Center of Saarland, Homburg/Saar, Germany.
⁸ Department of Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Infectiology, Pediatric Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
⁹ Department of Paediatric Infectious Diseases and Vaccinology, University Children's Hospital Basel (UKBB) and University of Basel, Basel, Switzerland.
¹⁰ Department of Oncology, University Children's Hospital Zurich, Zurich, Switzerland.
¹¹ Centre for Child and Adolescent Health, Helios Klinikum Krefeld, Germany.
¹² Department of Pediatrics, University Hospital Magdeburg, Magdeburg, Germany.
¹³ Clinic for Pediatric Oncology and Hematology, Hannover Medical School, Hannover, Germany.
¹⁴ Department of Paediatrics and Adolescent Medicine, Community Hospital Herdecke, Herdecke, Germany.
¹⁵ Children's Hospital Karlsruhe, Karlsruhe, Germany.
¹⁶ Campus University Medical School Hamburg (MSH), Helios Clinic Schwerin, Schwerin, Germany.
¹⁷ Department of Pediatric Oncology and Hematology, Klinikum Dortmund, Dortmund, Germany.
¹⁸ Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁹ Department of Pediatrics, Jena University Hospital, Jena, Germany.
²⁰ Section of Pediatric Oncology and Palliative Medicine, Klinik für Kinder- und Jugendmedizin, Universitätsmedizin Rostock, Rostock, Germany.
²¹ Department of Pediatrics and Pediatric Hematology/Oncology, University Children's Hospital, Carl von Ossietzky Universität Oldenburg, Klinikum Oldenburg AöR, Oldenburg, Germany.
²² Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
²³ Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany.
²⁴ Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria.
²⁵ Pediatric Oncology-Hematology, Children's Hospital of Central Switzerland, Lucerne, Switzerland.
²⁶ Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany.
²⁷ Pediatric Oncology and Hematology, University Medical Center Mannheim, Mannheim, Germany.
²⁸ Children's Hospital, Medical University Lausitz-Carl Thiem, Cottbus, Germany.
²⁹ Department of Pediatrics, Asklepios Children's Hospital, Sankt Augustin, Germany.
³⁰ Department of Hematology and Oncology, Children's Hospital Stuttgart-Olgahospital, Stuttgart, Germany.
³¹ Pediatric Hospital of Eastern Switzerland St Gallen, St Gallen, Switzerland.
³² Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany.
³³ Pediatric Oncology-Hematology, Children's Hopital, Cantonal Hospital Aarau, Aarau, Switzerland.
³⁴ Department of Pediatric Hematology, Oncology and Immunology, University Hospital Heidelberg, Heidelberg, Germany.
³⁵ Department of Pediatric Hematology and Oncology, Klinik Hallerwiese-Cnopfsche Kinderklinik, Nürnberg, Germany.
³⁶ Department of Pediatric Oncology, Hematology and Hemostaseology, University of Leipzig, Leipzig, Germany.
³⁷ Department of Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, Germany.
³⁸ Department of Pediatrics, Division of Hematology, Oncology and Hemostaseology, Goethe University Frankfurt, Frankfurt/Main, Germany, Frankfurt am Main, Germany.
³⁹ Pediatric Hematology and Oncology, University Hospital Giessen, Giessen, Germany.
⁴⁰ Clinic for Pediatric and Adolescent Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany.
⁴¹ Department of Pediatrics, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
⁴² Department of Pediatric Haematology, Oncology and Stem Cell Transplantation, University Medical Center, University Children's Hospital, University of Würzburg, Würzburg, Germany.
⁴³ Clinic for Children and Youth Medicine, Department for Pediatric Hematology/Oncology, Children's Hospital Amsterdamer Straße, Cologne, Germany.
⁴⁴ Swabian Children's Cancer Center, Pediatrics and Adolescent Medicine, University Medical Center Augsburg, Augsburg, Germany.
⁴⁵ Department of Paediatric Haematology/Oncology, Children's University Hospital, Tübingen, Germany.
⁴⁶ Department of Pediatrics and Children's Cancer Research Center, School of Medicine, Technical University of Munich, Munich, Germany.
⁴⁷ Pediatric Hematology and Oncology, Klinikum Kassel, Kassel, Germany.
⁴⁸ Division of Pediatric Oncology, Department of Pediatrics and Adolescent Medicine, Johannes Kepler University, Linz, Austria.
⁴⁹ Clinic for Pediatrics and Adolescent Medicine, Hematology/Oncology, Klinikum am Gesundbrunnen Heilbronn, Heilbronn, Germany.
⁵⁰ Department of Pediatrics and Adolescent Medicine University Clinics, Salzburg, Austria.
⁵¹ Department for Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany.
⁵² University Children's Hospital, Evangelisches Klinikum Bethel, Bielefeld, Germany.
⁵³ Department of Pediatric Hematology/Oncology, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
⁵⁴ Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany.
⁵⁵ Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria.
⁵⁶ Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg, Regensburg, Germany.
⁵⁷ Department of Pediatrics, University Hospital Schleswig-Holstein, Kiel, Germany.
⁵⁸ Pediatric Oncology Center, Bremen-Mitte, Professor Hess Children's Hospital, Bremen, Germany.
⁵⁹ Pediatric Hematology & Oncology, Gemeinschaftsklinikum Mittelrhein, Koblenz, Germany.
⁶⁰ Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.
⁶¹ Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany.
⁶² Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
⁶³ Children's Hospital, Vestische Youth Hospital, University of Witten/Herdecke, Datteln, Germany.
⁶⁴ Department of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
⁶⁵ Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Hospital Aachen, Aachen, Germany.
⁶⁶ Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
⁶⁷ Department of Hematology and Oncology, Center for Child and Adolescent Medicine, Städtisches Klinikum Braunschweig gGmbH, Braunschweig, Germany.
⁶⁸ Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
⁶⁹ German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
⁷⁰ Clinical Trials Centre Cologne (ZKS Köln), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.

PMID: 40515497
PMCID: PMC12166348
DOI: 10.1111/myc.70074

Abstract

Background: Invasive fungal diseases (IFD) pose significant challenges in paediatric oncology. Their management is complicated by limited paediatric-specific evidence, lack of standardised protocols and variability in resources across centres. This study assessed current practices and addressed the challenges in the prevention, diagnosis and treatment of IFDs in paediatric oncology centres across Germany, Austria and Switzerland.

Methods: A questionnaire was distributed to senior paediatric oncologists in 70 paediatric oncology centres across Germany, Austria and Switzerland, gathering data on centre infrastructure, infectious disease (ID) expertise, annual cumulative IFD incidence in 2023, diagnostic tools, antifungal prophylaxis, treatment and follow-up practices for IFD. Responses were analysed descriptively.

Results: Sixty-two centres responded, with a median of 56 (IQR 40-75) new oncological diagnoses per centre; 54.8% of centres managed allogeneic HCT patients. IFDs were reported in 88.7% of centres, with a median cumulative IFD incidence of 4.6% (IQR 3.0%-5.9%). No significant association was found between cumulative IFD incidence and the number of transplants, antifungal prophylaxis protocols and availability of ID consultation services. ID consultation was available in 58.1% of centres, with 24/7 support provided in 41.7% of these centres. Larger centres more frequently had paediatric ID specialists, ID consultation services and access to therapeutic drug monitoring.

Conclusions: The observed heterogeneity in mycology expertise and IFD management strategies across centres reflects the inherent complexity of IFDs and the diagnostic and therapeutic uncertainties amid limited evidence. Strengthening oncology-ID networks and implementing digital consultation platforms may promote high-quality, equitable care, particularly for those with fewer in-house resources.

Keywords: antifungal stewardship; aspergillosis; cancer; candidaemia; children; diagnosis; management; mycoses; prophylaxis; treatment.

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Conflict of interest statement

A.H.G. has received grants from Gilead, Merck, Sharp & Dohme and Pfizer and has served as a consultant to Amplyx, Astellas, Basilea, F2G, Gilead, Merck, Sharp & Dohme, Mundipharma, Pfizer and Scynexis. O.A.C. reports grants or contracts from iMi, iHi, DFG, BMBF, Cidara, DZIF, EU‐DG RTD, F2G, Gilead, MedPace, MSD, Mundipharma, Octapharma, Pfizer, Scynexis; consulting fees from Abbvie, AiCuris, Basilea, Biocon, Boston Strategic Partners, Cidara, Elion Therapeutics, Gilead, GSK, IQVIA, Janssen, Matinas, MedPace, Menarini, Melinta, Molecular Partners, MSG‐ERC, Mundipharma, Noxxon, Octapharma, Pardes, Partner Therapeutics, Pfizer, PSI, Scynexis, Seres, Seqirus, Shionogi, The Prime Meridian Group; speaker and lecture honoraria from Abbott, Abbvie, Akademie für Infektionsmedizin, Al‐Jazeera Pharmaceuticals/Hikma, amedes, AstraZeneca, Deutscher Ärzteverlag, Gilead, GSK, Grupo Biotoscana/United Medical/Knight, Ipsen Pharma, Medscape/WebMD, MedUpdate, MSD, Moderna, Mundipharma, Noscendo, Paul‐Martini‐Stiftung, Pfizer, Sandoz, Seqirus, Shionogi, streamedup!, Touch Independent, Vitis; payment for expert testimony from Cidara; participation on a DRC, DSMB, DMC, Advisory Board for AstraZeneca, Cidara, IQVIA, Janssen, MedPace, Melinta, PSI, Pulmocide, Vedanta Biosciences. Other authors had no conflicts of interest. T.N. has received authorship fees from uptodate.com (Wellesley, Massachusetts, USA) and reimbursement of travel expenses during consultancy work for the European Medicines Agency (EMA), steering committees of the PENTA Paediatric European Network for Treatment of AIDS (Padua, Italy), the Juvenile Inflammatory Cohort (JIR) (Lausanne, Switzerland). U.T. is funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)—Project number 501830041. T.L. served as a consultant to Gilead Sciences, Pfizer, Merck/MSD, Mundipharma, Roche, Recordati, GlaxoSmithKline and Pharming, and in the speaker's bureau of Gilead Sciences, Merck/MSD, AstraZeneca, Recordati, Pfizer, Mundipharma and Sanofi Pasteur. V.S. served as a consultant to Merck/MSD, Pfizer and SANOFI, and has received speaker honoraria from GlaxoSmithKline, Merck/MSD, Pfizer and SANOFI.

Figures

**FIGURE 1**
Distribution of 62 participating paediatric oncology centres (red) in Germany (51), Austria (5) and Switzerland (6) (invited centres without reply in grey). *Source:* www.google.de/maps.

**FIGURE 2**
Availability of laboratory diagnostics and diagnostic imaging and procedures in 62 paediatric cancer centres. (A) Laboratory diagnostics. Crypto AG, *Cryptococcus* antigen; GM, galactomannan; Histo, histopathology; Micro, microscopy; NGS, next generation sequencing; Suscept, susceptibility testing. Colour code: % percentage (orange), N: number of cases (blue shades). (B) Diagnostic imaging and procedures. Bronch, bronchoscopy; CT, computed tomography; IGB, image‐guided biopsy; MRI, magnetic resonance imaging; PET, PET‐CT/PET‐MRI; Sono, sonography; Xray, radiography. ^§IGB responses are available from 57/62 centres (47/51 Germany, 5/5 Austria, 5/6 Switzerland).

**FIGURE 3**
Preferred antifungal prophylaxis in different patient populations in 62 paediatric cancer centres (percent). ALL, acute lymphocytic leukaemia; AMB, liposomal amphotericin B; AML, acute myeloid leukaemia; CASP, caspofungin; FLU, fluconazole; GvHD, graft‐versus‐host disease; HCT, haematopoietic cell transplantation; ITRA, itraconazole; MCFG, micafungin; NA, not applicable; POSA, posaconazole; VRC, voriconazole.

**FIGURE 4**
First‐line antifungal of choice and alternative for (A) candidaemia and (B) invasive pulmonary aspergillosis in 62 paediatric cancer centres. Combi, antifungal‐combination therapy; Echino, echinocandin; FLU, fluconazole; ISAV, isavuconazole; L‐AMB, liposomal amphotericin B; POSA, posaconazole; VRC, voriconazole. (A) Candidaemia (centres with multiple preferred first‐line (N = 4) or alternative agents (N = 16) were included based on their respective choices). (B) Invasive pulmonary aspergillosis (centres with multiple preferred first‐line (N = 14) or alternative treatments (N = 24) were included based on their respective choices).

**FIGURE 5**
Follow‐up strategies for candidaemia and invasive pulmonary aspergillosis in 62 paediatric cancer centres. (A) Candidaemia. BC, blood culture; Echocard, echocardiography; Ophthal, ophthalmoscopy, Sono, sonography abdomen. (B) Invasive pulmonary aspergillosis. cCT, cranial computed tomography, GM, galactomannan, MRI, magnetic resonance imaging.

See this image and copyright information in PMC

References

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Approaches to Invasive Fungal Diseases in Paediatric Cancer Centres: An Analysis of Current Practices and Challenges in Germany, Austria and Switzerland

Affiliations

Approaches to Invasive Fungal Diseases in Paediatric Cancer Centres: An Analysis of Current Practices and Challenges in Germany, Austria and Switzerland

Authors

Affiliations

Abstract

Conflict of interest statement

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Medical