Occurrence and case fatality rate of invasive aspergillosis in children with acute leukemia: A systematic review and meta-analysis

Invasive aspergillosis (IA) is a potentially life-threatening complication of childhood acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). We conducted a systematic review and meta-analyses of studies on acute leukemia in children aged 0-17 years since 2000. Findings were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We included 24 studies with 3,661 ALL patients and 1,728 AML patients. IA cumulative incidence varied (0%-10% for ALL and 0%-18% for AML) across the studies. Pooled cumulative IA incidences were estimated at 3.2% (95% CI: 1.8% - 5.8%) in ALL and 5.2% (95% CI: 3.1% - 8.6%) in AML, with corresponding case-fatality-rates of 13.3% (95% CI: 6.3% - 25.9%) and 7.8% (95% CI: 0.7% - 51.2%), respectively. Our analysis highlights the impact of IA in childhood leukemia, underscoring the need to address strategies for prevention, early detection, and treatment of IA in pediatric leukemia.