title: Association between corticosteroids and infection, sepsis, and infectious death in pediatric acute myeloid leukemia (AML): results from the Canadian infections in AML research group.
abstract: BACKGROUND
  Infection continues to be a major problem for children with acute myeloid leukemia (AML). Objectives were to identify factors associated with infection, sepsis, and infectious deaths in children with newly diagnosed AML.
  
  
  METHODS
  We conducted a retrospective, population-based cohort study that included children ≤ 18 years of age with de novo, non-M3 AML diagnosed between January 1995 and December 2004, treated at 15 Canadian centers. Patients were monitored for infection from initiation of AML treatment until recovery from the last cycle of chemotherapy, conditioning for hematopoietic stem cell transplantation, relapse, persistent disease, or death (whichever occurred first). Consistent trained research associates abstracted all information from each site.
  
  
  RESULTS
  341 patients were included. Median age was 7.1 years (interquartile range [IQR], 2.0-13.5) and 29 (8.5%) had Down syndrome. In sum, 26 (7.6%) experienced death as a first event. There were 1277 courses of chemotherapy administered in which sterile site microbiologically documented infection occurred in 313 courses (24.5%). Sepsis and infectious death occurred in 97 (7.6%) and 16 (1.3%) courses, respectively. The median days of corticosteroid administration was 2 per course (IQR, 0-6). In multiple regression analysis, duration of corticosteroid exposure was significantly associated with more microbiologically documented sterile site infection, bacteremia, fungal infection, and sepsis. The only factor significantly associated with infectious death was days of corticosteroid exposure (odds ratio, 1.05; 95% confidence interval, 1.02-1.08; P = .001).
  
  
  CONCLUSIONS
  In pediatric AML, infection, sepsis, and infectious death were associated with duration of corticosteroid exposure. Corticosteroids should be avoided when possible for this population.
authors.affiliation: Pediatric Hematology/Oncology, British Columbia Children's Hospital, Vancouver, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Dix
authors.forename: Sonia
authors.initials: S
authors.lastname: Cellot
authors.forename: Victoria
authors.initials: V
authors.lastname: Price
authors.forename: Biljana
authors.initials: B
authors.lastname: Gillmeister
authors.forename: Marie-Chantal
authors.initials: MC
authors.lastname: Ethier
authors.forename: Donna L
authors.initials: DL
authors.lastname: Johnston
authors.forename: Victor
authors.initials: V
authors.lastname: Lewis
authors.forename: Bruno
authors.initials: B
authors.lastname: Michon
authors.forename: David
authors.initials: D
authors.lastname: Mitchell
authors.forename: Kent
authors.initials: K
authors.lastname: Stobart
authors.forename: Rochelle
authors.initials: R
authors.lastname: Yanofsky
authors.forename: Carol
authors.initials: C
authors.lastname: Portwine
authors.forename: Mariana
authors.initials: M
authors.lastname: Silva
authors.forename: Lynette
authors.initials: L
authors.lastname: Bowes
authors.forename: Shayna
authors.initials: S
authors.lastname: Zelcer
authors.forename: Josée
authors.initials: J
authors.lastname: Brossard
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Traubici
authors.forename: Upton
authors.initials: U
authors.lastname: Allen
authors.forename: Joseph
authors.initials: J
authors.lastname: Beyene
authors.forename: Lillian
authors.initials: L
authors.lastname: Sung
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications / Q000453:epidemiology; D001424:Bacterial Infections / Q000150:complications / Q000453:epidemiology*; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000453:epidemiology* / Q000382:microbiology* / Q000601:surgery / Q000628:therapy; D008297:Male; D012044:Regression Analysis; D012189:Retrospective Studies
chemical_list: D000305:Adrenal Cortex Hormones