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Published on: March 5, 2018
Microbiologically documented infections and infection-related mortality in children with acute myeloid leukemia
Lillian Sung1, Beverly J Lange, Robert B Gerbing
1Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada. lillian.sung@sickkids.ca
Abstract:
The primary objective was to describe the prevalence and characteristics of microbiologically defined infections and infection-related mortality (IRM) in 492 children with acute myeloid leukemia enrolled on CCG 2961. Secondary objectives were to determine the relationship between demographic, disease-related, and therapeutic variables, and infections and IRM. Institutions documented infections prospectively. Age, ethnicity, body mass index, leukemia karyotype, treatment, and institutional size were examined for association with infection outcomes. More than 60% of children experienced such infections in each of 3 phases of chemotherapy. There were 58 infectious deaths; cumulative incidence of IRM was 11% plus or minus 2%. Thirty-one percent of infectious deaths were associated with Aspergillus, 25.9% with Candida, and 15.5% with alpha hemolytic streptococci. Age older than 16 years (hazard ratio [HR], 3.32; 95% confidence interval [CI], 1.87-5.89; P < .001), nonwhite ethnicity (HR, 1.85; 95% CI, 1.10-3.09; P = .02), and underweight status (HR, 3.06; 95% CI, 1.51-6.22; P = .002) were associated with IRM, while size of the treating institution was not. Thus, age, ethnicity, and BMI were important contributors to IRM. Fungi and Gram-positive cocci were the most common organisms associated with IRM and, in particular, Aspergillus species was the largest contributor to infectious deaths.
Insights
Infections are common in children with acute myeloid leukemia (AML), with over 60% affected during chemotherapy. Older age, non-white ethnicity, and underweight status significantly increase infection-related mortality (IRM) risk.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Acute myeloid leukemia (AML) treatment in children involves intensive chemotherapy, increasing susceptibility to infections.
- Infection-related mortality (IRM) remains a significant concern in pediatric AML patients.
- Understanding risk factors for infections and IRM is crucial for improving outcomes.
Purpose of the Study:
- To determine the prevalence and characteristics of infections and IRM in pediatric AML patients on CCG 2961.
- To identify demographic, disease-related, and therapeutic factors associated with infections and IRM.
Main Methods:
- Prospective documentation of infections in 492 children with AML.
- Analysis of age, ethnicity, body mass index (BMI), leukemia karyotype, treatment, and institutional size.
- Statistical examination of associations with infection outcomes and IRM.
Main Results:
- Over 60% of children experienced infections during each of the three chemotherapy phases.
- The cumulative incidence of IRM was 11% ± 2%.
- Independent risk factors for IRM included age >16 years, non-white ethnicity, and underweight BMI. Aspergillus was the leading cause of infectious deaths.
Conclusions:
- Age, ethnicity, and BMI are significant contributors to IRM in pediatric AML.
- Fungi (especially Aspergillus) and Gram-positive cocci are the most common pathogens associated with IRM.
- Targeted interventions addressing these risk factors may reduce IRM in pediatric AML.
