Incidence of bacteremias and invasive mycoses in children with high risk neuroblastoma.
BACKGROUND
Information on the incidence of infectious complications during for treatment for high risk neuroblastoma (HR-NB) is limited. Bacteremias and invasive mycoses may be considered surrogate markers of the infection burden.


METHODS
Data on bacteremias and invasive mycoses occurring during 3 consecutive protocols for front line (NB-89; NB-92; NB-97) or salvage therapy (TVD) for HR-NB were reviewed. The cumulative risk of developing a first episode and the rate of infections during the entire length of each protocol were evaluated.


RESULTS
Front line protocols were given to 80 patients for a total of 22,070 days at risk; salvage treatment was given to 24 children for 2,909 days at risk. During front line therapy 41 infectious episodes were diagnosed in 29 (36%) patients, for a 45% cumulative risk and an infection rate (IR) of 0.19/100 patient-days-at risk. Salvage therapy determined five infectious episodes in four (17%) patients, with a 39% cumulative risk, and an IR of 0.17. The IR during the phase of high dose chemotherapy with hematopoietic stem cell rescue (megatherapy) included in the three front line protocols decreased over time (1.54 in NB-89; 0.52 in NB-92 and 0.0 in NB 97; P = 0.001), possibly because of the use of less aggressive conditioning regimens, without radiotherapy.


CONCLUSIONS
The IRs of protocols for HR-NB did not change over time. The megatherapy-related phases are those at highest risk.
Castagnola
Elio
E
Infectious Diseases Unit, G. Gaslini Children Hospital, Genoa, Italy. eliocastagnola@ospedale-gaslini.ge.it
Conte
Massimo
M
Parodi
Stefano
S
Papio
Filippo
F
Caviglia
Ilaria
I
Haupt
Riccardo
R
D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D016470:Bacteremia / Q000139:chemically induced / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007223:Infant; D009181:Mycoses / Q000139:chemically induced / Q000209:etiology*; D009447:Neuroblastoma / Q000150:complications* / Q000628:therapy; D012189:Retrospective Studies; D012306:Risk; D016879:Salvage Therapy; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods
D000970:Antineoplastic Agents