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Serious infections during continuing treatment of acute lymphoblastic leukaemia
Insights
Young children with acute lymphoblastic leukemia (ALL) face higher infection risks during treatment. Measles, a preventable disease, poses a significant threat, highlighting the need for targeted interventions.
Area of Science:
- Pediatric Oncology
- Infectious Diseases in Immunocompromised Patients
- Hematology
Background:
- Children undergoing treatment for acute lymphoblastic leukemia (ALL) are susceptible to infections.
- Hospitalization due to infections is a common complication during ALL therapy.
- Understanding risk factors for infection is crucial for optimizing patient care.
Purpose of the Study:
- To assess the incidence and duration of infectious hospitalizations in children with ALL post-induction therapy.
- To identify patient and treatment-related factors associated with increased infection risk.
- To determine the impact of infections on mortality in this pediatric population.
Main Methods:
- Retrospective analysis of 168 children with ALL who completed induction therapy and central nervous system prophylaxis.
- Calculation of hospitalization time as a proportion of total days at risk.
- Analysis of mortality data and causes of death related to infection.
Main Results:
- 76 out of 168 children (45%) were hospitalized at least once for infection.
- Mean hospitalization time was 1 day in 75 days at risk; 37% experienced longer durations.
- Younger children (<5 years) and those on intensive protocols had higher risks; deaths (8.3%) were linked to measles, sepsis, and CMV, particularly in the first two years.
Conclusions:
- Younger children and those on intensive ALL treatment protocols are at higher risk of infectious hospitalizations.
- Measles, a preventable infection, is a significant cause of mortality in this cohort.
- Focusing on preventable infections like measles is critical for improving outcomes in pediatric ALL patients.
Abstract:
Seventy-six of 168 children with acute lymphoblastic leukaemia, who had completed induction therapy and central nervous system prophylaxis, were each admitted to hospital at least once during subsequent treatment with an infectious illness. The time spent in hospital was calculated as a proportion of the total number of days at risk and had a mean value of one day in 75. Sixty-three (37%) children spent longer than this in hospital, particularly patients younger than 5 years and those on a more intensive protocol; a third year of treatment appeared to carry no significant addition risk of infection. Death due to infection occurred in 14 (8.3%) children; these deaths were more common in younger patients and during the first 2 years of treatment and were mainly due to measles, septicaemia, or cytomegalovirus. These findings show that younger children and those receiving more intensive treatment are at greater risk of infection. The risk is not one of exotic infections, but of measles, a preventable disease.