Infectious complications in pediatric acute myeloid leukemia: analysis of the prospective multi-institutional clinical trial AML-BFM 93.
Infections still remain a major cause of therapy-associated morbidity and mortality in children with acute myeloid leukemia (AML). To improve supportive care measurements, detailed information on frequency and characteristic features of infectious complications is needed. We retrospectively analyzed the medical charts of 304 children, treated in 30 hospitals according to the multi-institutional clinical trial AML-BFM 93. Overall, 855 infectious complications occurred in 304 patients (fever without identifiable source (n=523; 61.2%), clinically (n=57; 6.7%) and microbiologically documented infections (n=275; 32.1%)). Neutropenia was present in 74.1% of the infectious episodes. In all, 20 patients died of infection-associated complications (15/276 (5.4%) patients without and 5/28 (17.9%) with Down syndrome), most of them during early induction therapy (n=11). Blood stream infections occurred in 228 episodes (Gram-positive (n=202) and Gram-negative (n=42) pathogens). Invasive fungal infection was probable or proven in 15 patients. In 113 out of the 855 infectious episodes (13.3%), pneumonia was radiologically diagnosed. Better strategies of supportive care might help to improve overall survival in children undergoing chemotherapy for AML. Therefore, children with AML should be treated in specialized pediatric centers, and there should be a very low threshold to readmit patients, in particular patients with pulmonary symptoms.
Department of Pediatric Hematology and Oncology, Children's Hospital of the University of Frankfurt/Main, Germany. thomas_lehrnnbecher@yahoo.com
T
T
Lehrnbecher
D
D
Varwig
J
J
Kaiser
D
D
Reinhardt
T
T
Klingebiel
U
U
Creutzig
D000208:Acute Disease; D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016470:Bacteremia / Q000209:etiology / Q000401:mortality; D001419:Bacteria / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D003561:Cytarabine / Q000008:administration & dosage; D004314:Down Syndrome / Q000150:complications / Q000382:microbiology; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005334:Fever / Q000150:complications / Q000209:etiology; D016905:Gram-Negative Bacterial Infections / Q000209:etiology* / Q000401:mortality; D016908:Gram-Positive Bacterial Infections / Q000209:etiology* / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007951:Leukemia, Myeloid / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008942:Mitoxantrone / Q000008:administration & dosage; D009503:Neutropenia / Q000150:complications / Q000209:etiology; D011446:Prospective Studies; D012189:Retrospective Studies; D013866:Thioguanine / Q000008:administration & dosage
D003561:Cytarabine; D005047:Etoposide; D008942:Mitoxantrone; D013866:Thioguanine