# P-471. Approaches to Invasive Fungal Diseases in Pediatric Cancer Centers: An Analysis of Current Practices and Challenges in Germany, Austria, and Switzerland

## TL;DR

This study examines how pediatric cancer centers in Germany, Austria, and Switzerland manage invasive fungal diseases, revealing varied practices and challenges in diagnosis and treatment.

## Contribution

The study provides insights into current practices and disparities in managing invasive fungal diseases in pediatric oncology centers across the DACH region.

## Key findings

- There is significant variation in diagnostic tools and treatment protocols for invasive fungal diseases among centers.
- Larger centers are more likely to have infectious disease specialists and standardized antifungal protocols.
- Prophylaxis strategies and access to therapeutic drug monitoring are inconsistent across centers.

## Abstract

Invasive fungal diseases (IFDs) cause high morbidity and mortality in children with cancer and hematopoietic cell transplantation (HCT). While international guidelines exist for prevention, diagnosis, and treatment, pediatric-specific evidence remains limited and practices vary.

Geographic distribution of the 62 participating pediatric oncology centers

First-line and first-line alternative antifungal treatment for candidemia and invasive pulmonary aspergillosis in 62 pediatric oncology centers

In Jun-Sep 2024, we surveyed 72 pediatric oncology centers in Germany, Austria, and Switzerland (German Society for Paediatric Oncology and Haematology) using a questionnaire covering center volume, ID expertise, diagnostic tools, prophylaxis protocols, therapeutic drug monitoring (TDM), and treatment pathways for aspergillosis and candidemia. Data were analyzed descriptively; associations between center size, ID resources, and IFD incidence were tested via Mann–Whitney U and linear regression.

Sixty-two centers (86% response) participated: 51 DE, 5 AT, 6 CH (Figure 1). Median new oncology cases in 2023 was 56 (IQR 40–75); 55% managed HCT. Proven or probable IFDs were reported by 89% of centers at a median incidence of 4.6% (IQR 3.0–5.9%). A pediatric ID specialist was available in 58% of centers (100% CH, 51% DE, 40% AT); 58% offered formal ID consultation (24% 24/7). Larger centers more often had ID specialists (p=0.008) and maintained antifungal SOPs (p=0.02). All centers performed culture and histopathology; galactomannan testing in 94%, β-D-glucan in 53%, PCR in 86%. In-house TDM for voriconazole was available in 52%, less frequently for posaconazole and isavuconazole. Prophylaxis strategies varied, with liposomal amphotericin B (AMB) used most frequently across risk groups. AMB was the preferred first-line therapy for invasive pulmonary aspergillosis (71% of centers) and candidemia (45%), followed by voriconazole and echinocandin, retrospectively (Figure 2).

Heterogeneity exists in IFD management across pediatric oncology centers in the DACH region, influenced by center size and ID resource availability. Gaps include inconsistent SOPs, limited 24/7 ID support, and incomplete access to TDM. Strengthening oncology–ID collaborations, standardizing SOPs, and enhancing antifungal stewardship -potentially via digital platforms- may harmonize care and improve outcomes for children at risk of IFD.

Oliver A. Cornely, Prof. Dr., Al-Jazeera Pharmaceuticals/Hikma: Honoraria|Basilea: Advisor/Consultant|Cidara: Advisor/Consultant|Cidara: Board Member|Cidara: Grant/Research Support|Elion: Advisor/Consultant|F2G: Grant/Research Support|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Honoraria|Grupo Biotoscana/United Medical/Knight: Honoraria|Melinta: Advisor/Consultant|Melinta: Board Member|MSD: Honoraria|Mundipharma: Advisor/Consultant|Mundipharma: Grant/Research Support|Mundipharma: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Pulmocide: Board Member|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Honoraria Andreas H. Groll, MD, Basilea: Advisor/Consultant|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Merck, Sharp & Dohme: Advisor/Consultant|Mundipharma: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Honoraria