title: Infectious complications in children with acute myeloid leukemia: decreased mortality in multicenter trial AML-BFM 2004.
abstract: Infections are an important cause for morbidity and mortality in pediatric acute myeloid leukemia (AML). We therefore characterized infectious complications in children treated according to the trial AML-BFM 2004. Patients with Down syndrome were excluded from the analysis. Data were gathered from the medical records in the hospital where the patients were treated. A total of 405 patients (203 girls; median age 8.4 years) experienced 1326 infections. Fever without identifiable source occurred in 56.1% of the patients and clinically and microbiologically documented infections in 17.5% and 32.4% of the patients, respectively. In all, 240 Gram-positive (112 viridans group streptococci) and 90 Gram-negative isolates were recovered from the bloodstream. Invasive fungal infection was diagnosed in 3% of the patients. Three children each died of Gram-negative bacteremia and invasive aspergillosis, respectively. As compared with the results of AML-BFM 93 with lower dose intensity, infection-related morbidity was slightly higher in AML-BFM 2004 (3.3. versus 2.8 infections per patient), whereas infection-related mortality significantly decreased (1.5% versus 5.4%; P=0.003). Specific anti-infective recommendations included in the treatment protocol, regular training courses for pediatric hematologists and increasing experience may be the reason for reduced infection-related mortality in children with AML. Further studies are needed to decrease infection-related morbidity.
authors.affiliation: Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Bochennek
authors.affiliation: Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Hassler
authors.affiliation: Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Perner
authors.affiliation: Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Gilfert
authors.affiliation: Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Schöning
authors.affiliation: Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Klingebiel
authors.affiliation: Paediatric Hematology and Oncology, Medical Center, University of Essen, Essen, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Reinhardt
authors.affiliation: Department of Pediatric Hematology and Oncology, Children's Hospital, Hannover Medical School, Hannover, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Creutzig
authors.affiliation: Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Lehrnbecher
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000209:etiology* / Q000401:mortality*; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D018805:Sepsis / Q000209:etiology / Q000401:mortality