{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T10:09:37Z","timestamp":1790244577512,"version":"4.1.0"},"reference-count":16,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Preemptive antifungal therapy in neutropenic fever offers a rational alternative to the empiric strategy, potentially reducing drug toxicity, resistance, and treatment\u2010related costs. However, its implementation in the Middle East and North Africa (MENA) region remains insufficiently addressed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We prospectively observed episodes of neutropenia in pediatric patients with solid tumors and prolonged neutropenia. This non\u2010inferiority cohort study evaluated two primary endpoints: the cumulative incidence of invasive fungal infection (IFI), IFI\u2010attributable mortality. Outcomes from the prospective cohort managed with a preemptive strategy were compared with retrospective data from a historical cohort treated with the previously used empiric approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 422 preemptive episodes were prospectively recorded, and data from 338 historical empiric episodes were retrospectively reviewed. The incidence of IFI was comparable between the two groups (4.5% in the preemptive group vs. 5.6% in the empiric group;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.5). However, antifungal use was significantly lower in the preemptive group (5.0% vs. 58.0%;\n                      <jats:italic>p\u00a0<\/jats:italic>\n                      &lt;\u00a00.001). Overall survival was higher in the preemptive group (98.9% vs. 94.6%). No IFI\u2010attributable mortality was recorded in either group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>The combined EIA\/HRCT\u2010based preemptive strategy is feasible and associated with reduced antifungal use without compromising patient outcomes in pediatric patients with solid tumors and prolonged neutropenia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1545-5017.70095","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T08:29:18Z","timestamp":1767083358000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preemptive Versus Empirical Antifungal Therapy for High\u2010Risk, Febrile, Neutropenic Solid Tumor Patients in an LMIC Setting"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1089-1659","authenticated-orcid":false,"given":"Omnia","family":"Al\u2010Qadi","sequence":"first","affiliation":[{"name":"Pediatric Oncology Department and Pediatric Stem Cell Transplantation Unit Children's Cancer Hospital Egypt (CCHE 57357)  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lobna","family":"Shalaby","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Department and Pediatric Stem Cell Transplantation Unit Children's Cancer Hospital Egypt (CCHE 57357)  Cairo Egypt"},{"name":"Pediatric Oncology Department and Hematopoietic Stem Cell Transplantation National Cancer Institute (NCI) Cairo University  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mervat El","family":"Anany","sequence":"additional","affiliation":[{"name":"Microbiology Department Children's Cancer Hospital Egypt (CCHE 57357)  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iman","family":"Zaky","sequence":"additional","affiliation":[{"name":"Radiology Department Children's Cancer Hospital Egypt (CCHE 57357)  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maggie","family":"Naguib","sequence":"additional","affiliation":[{"name":"Pediatrics Department Faculty of Medicine Cairo University Children's Hospital  Cairo Egypt"},{"name":"Pediatric Pulmonology Department Children's Cancer Hospital Egypt (CCHE 57357)  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0263-2680","authenticated-orcid":false,"given":"Amr","family":"Kashef","sequence":"additional","affiliation":[{"name":"Pharmacy Department Children's Cancer Hospital Egypt (CCHE 57357)  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omneya","family":"Hassanain","sequence":"additional","affiliation":[{"name":"Biostatistics and Epidemiology Unit Research Department Children's Cancer Hospital Egypt (CCHE 57357)  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manal","family":"Zamzam","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Department and Pediatric Stem Cell Transplantation Unit Children's Cancer Hospital Egypt (CCHE 57357)  Cairo Egypt"},{"name":"Pediatric Oncology Department and Hematopoietic Stem Cell Transplantation National Cancer Institute (NCI) Cairo University  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie","family":"Lehmann","sequence":"additional","affiliation":[{"name":"Pediatric Hematology Oncology and Stem Cell Transplantation Unit Dana Farber\/ Children's Hospital Cancer Care Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaa El","family":"Haddad","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Department and Pediatric Stem Cell Transplantation Unit Children's Cancer Hospital Egypt (CCHE 57357)  Cairo Egypt"},{"name":"Pediatric Oncology Department and Hematopoietic Stem Cell Transplantation National Cancer Institute (NCI) Cairo University  Cairo 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