Infectious complications in children with acute myeloid leukemia: decreased mortality in multicenter trial AML-BFM
K Bochennek1, A Hassler1, C Perner1
1Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany.
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.
Insights
Infections pose risks for children with acute myeloid leukemia (AML). While infection-related morbidity slightly increased, the AML-BFM 2004 trial significantly reduced infection-related mortality in pediatric AML patients.
Area of Science:
- Pediatric Hematology Oncology
- Infectious Diseases in Immunocompromised Hosts
Background:
- Infections are a major cause of morbidity and mortality in pediatric acute myeloid leukemia (AML).
- Characterizing infectious complications is crucial for improving treatment outcomes.
Purpose of the Study:
- To analyze infectious complications in children with AML treated under the AML-BFM 2004 trial.
- To compare infection-related morbidity and mortality with previous trials.
Main Methods:
- Retrospective analysis of medical records from 405 pediatric AML patients (excluding Down syndrome).
- Data collection on infection types, causative agents, and outcomes.
- Comparison with historical data from the AML-BFM 93 trial.
Main Results:
- A total of 1326 infections were recorded, with fever of unknown origin in 56.1%.
- Gram-positive and Gram-negative bacteria were common bloodstream isolates; invasive fungal infections occurred in 3%.
- Infection-related mortality significantly decreased from 5.4% in AML-BFM 93 to 1.5% in AML-BFM 2004 (P=0.003), despite slightly higher morbidity.
Conclusions:
- The AML-BFM 2004 protocol, along with enhanced anti-infective strategies and increased experience, led to a significant reduction in infection-related mortality in pediatric AML.
- Further research is needed to decrease infection-related morbidity in this vulnerable population.
