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Published on: March 5, 2018
Infectious complications in pediatric acute myeloid leukemia: analysis of the prospective multi-institutional
T Lehrnbecher1, D Varwig, J Kaiser
1Department of Pediatric Hematology and Oncology, Children's Hospital of the University of Frankfurt/Main, Germany. thomas_lehrnnbecher@yahoo.com
Abstract:
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.
Insights
Infections are a major risk for children with acute myeloid leukemia (AML). Improved supportive care and specialized treatment centers are crucial for reducing infection-related deaths in pediatric AML patients.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Infections are a significant cause of morbidity and mortality in pediatric patients undergoing treatment for acute myeloid leukemia (AML).
- Detailed understanding of infectious complications is essential for enhancing supportive care strategies.
Purpose of the Study:
- To analyze the frequency and characteristics of infectious complications in children with AML.
- To identify factors influencing infection-associated mortality and inform improved supportive care.
Main Methods:
- Retrospective analysis of medical charts from 304 children treated in 30 hospitals.
- Data collected from the multi-institutional clinical trial AML-BFM 93.
Main Results:
- 855 infectious complications were recorded, with fever of unknown origin being most common (61.2%).
- Neutropenia was present in 74.1% of episodes; 20 patients died from infections, particularly during induction therapy.
- Bloodstream infections (228 episodes) and pneumonia (13.3%) were frequent, with Gram-positive pathogens predominating.
Conclusions:
- Children with AML face substantial infectious risks, impacting survival.
- Specialized pediatric centers and prompt readmission for pulmonary symptoms are recommended to improve outcomes.
- Enhanced supportive care strategies are vital for improving survival rates in pediatric AML.
