Abstract Background Invasive pulmonary aspergillosis (IPA) is the most common invasive fungal infection among immunocompromised pediatric patients, particularly those with hematologic malignancies, and continues to be associated with high mortality. Despite advances in antifungal therapy and supportive care, data on prognostic factors for survival in children, especially in Latin America, remain limited. Objective To evaluate the role of lymphopenia and corticosteroid exposure on 12-week overall survival in pediatric oncology patients diagnosed with probable or proven IPA, and to identify additional clinical and paraclinical factors associated with mortality in this population. Methods A retrospective cohort study was conducted at Fundación Hospital Pediátrico La Misericordia (HOMI) in Bogotá, Colombia. Medical records from January 2012 to December 2022 were reviewed for patients aged 1 month to 17 years with a confirmed oncologic diagnosis and proven or probable IPA, as defined by EORTC/MSGERC 2012 criteria. Demographic, clinical, and laboratory variables were analyzed. Survival time was assessed using Kaplan-Meier analysis, and Cox proportional hazards models were built to identify predictors of mortality. The main outcome was 12-week overall survival from symptom onset. Results A total of 112 patients were included (median age: 103.5 months; 58.9% male). Acute lymphoblastic leukemia was the most frequent malignancy (63.4%), followed by acute myeloid leukemia (18.8%). Probable IPA was diagnosed in 95.5% of patients. At presentation, 62.5% had neutropenia and 54.5% had lymphopenia; 15.2% had received corticosteroids, and 18.8% had a history of hematopoietic stem cell transplantation. Ground-glass opacities (68.8%) and pulmonary nodules (38.4%) were the predominant radiologic findings. Voriconazole was the most commonly used antifungal (55.4%). During follow-up, 61.6% required PICU admission and 38.4% required mechanical ventilation. The 12-week mortality was 27.7%. In multivariate analysis, lymphopenia was independently associated with mortality (HR 3.05; 95% CI 1.40-6.62), adjusted for mechanical ventilation and stem cell transplantation. Corticosteroid use showed a non-significant trend toward lower survival (HR 0.52; 95% CI 0.21-1.25), though power was limited (32%). Conclusions Lymphopenia is an independent prognostic factor for decreased survival in pediatric oncology patients with IPA. The high frequency of critical illness requiring intensive care underscores the need for early diagnosis and aggressive management. While corticosteroid exposure may influence outcomes, further multicenter prospective studies are needed to clarify its role. This study provides the first systematic characterization of IPA survival in Colombian children with cancer, offering valuable insight for regional clinical practice and future research. This abstract is funded by: None
Restrepo et al. (Fri,) studied this question.