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Updated: Jun 20, 2026
Murine Model of Leukemia Relapse to Induction Chemotherapy for Acute Lymphoblastic Leukemia
Published on: October 17, 2025
Risk factors for infection-related outcomes during induction therapy for childhood acute lymphoblastic leukemia
Samina Afzal1, Marie-Chantal Ethier, L Lee Dupuis
1Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Background:
The primary objective was to describe microbiologically documented infections during induction therapy for acute lymphoblastic leukemia. The secondary objectives were to describe risk factors for microbiologically documented infections and for patients with a febrile episode, to identify risk factors for recurrence of fever or reinitiation of antibiotics.
Methods:
This study was a retrospective review of children from 1 to 18 years of age who received induction chemotherapy between March 1997 and September 2006. Microbiologically documented infections were examined through the induction period.
Results:
There were 425 children evaluated. The most common pre-existing risk factor for infection was Down syndrome in 11 children. Of the 425 children, 83 (19.5%) experienced at least one microbiologically documented infection. There were 85 infections consisting of 65 bacterial, 15 viral and 5 fungal infections.Variables significantly associated with a microbiologically documented infection were pre-existing risk factors (odds ratio [OR]: 3.63; P = 0.01) and neutropenia at initial infectious episode (OR: 1.86; P = 0.03). Factors associated with recurrence of fever and reinitiation of antibiotics after an initial infectious episode were receipt of a 4-drug induction, neutropenia at the initial infectious episode, initial fever documented in hospital, and lack of bone marrow recovery at the time of initial antibiotic cessation.
Conclusions:
About 20% of children with acute lymphoblastic leukemia have a microbiologically documented infection during induction. Those with pre-existing risk factors and neutropenia at the initial infectious episode were at higher risk of microbiologically documented infection. Continued efforts to refine risk groups may allow for risk-directed prophylactic or empiric strategies.
Insights
Approximately 20% of children with acute lymphoblastic leukemia (ALL) develop documented infections during induction therapy. Pre-existing risk factors and neutropenia increase infection risk in pediatric ALL patients.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Acute lymphoblastic leukemia (ALL) induction therapy carries a significant risk of infection in pediatric patients.
- Understanding infection patterns and risk factors is crucial for optimizing treatment and patient outcomes.
Purpose of the Study:
- To describe microbiologically documented infections during induction therapy for pediatric acute lymphoblastic leukemia (ALL).
- To identify risk factors associated with these infections, febrile episodes, and antibiotic reinitiation.
Main Methods:
- Retrospective review of children (1-18 years) undergoing ALL induction chemotherapy (March 1997 - September 2006).
- Analysis of microbiologically documented infections throughout the induction period.
Main Results:
- 83 out of 425 children (19.5%) had at least one documented infection (65 bacterial, 15 viral, 5 fungal).
- Pre-existing risk factors (OR: 3.63) and neutropenia (OR: 1.86) were significantly associated with documented infections.
- Factors for fever recurrence included 4-drug induction, neutropenia, in-hospital fever, and delayed bone marrow recovery.
Conclusions:
- Nearly 20% of pediatric ALL patients experience documented infections during induction.
- Pre-existing risk factors and neutropenia are key predictors of infection risk.
- Refining risk stratification may enable targeted prophylactic and empiric treatment strategies.
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