Infection-related mortality in children with acute lymphoblastic leukemia: an analysis of infectious deaths on UKALL2003
Infection-related mortality in children with acute lymphoblastic leukemia: an analysis of infectious deaths on UKALL2003
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DOI：
10.1182/blood-2014-03-560847
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发表时间：
2014-08-14
期刊：
影响因子：
20.3
通讯作者：
Samarasinghe, Sujith
中科院分区：
文献类型：
--
作者：
O'Connor, David;Bate, Jessica;Samarasinghe, Sujith
尽管感染是儿童急性淋巴细胞白血病治疗相关死亡(TRM)的主要原因，但与感染相关死亡(IRM)相关的因素却知之甚少。为了解决这个问题，我们报告了2003年英国儿童急性淋巴母细胞性白血病随机试验(UKALL 2003)中所有75例IRM病例的分析。5年累积发病率为2.4%(95%可信区间，1.9%-3.0%)，占249例试验死亡中的75例(30%)和117例TRM死亡中的75例(%)。IRM在诱导期的风险占TRM的比例高于其他阶段(77%比56%；P=0.02)。合并细菌感染(革兰氏阴性)占68%，合并真菌感染占20%。唐氏综合征是IRM最显著的危险因素(优势比[OR]，12.08；95%CI，6.54-22.32；P<；0.0001)。此外，女孩的IRM有增加的趋势(OR，1.63；95%CI，1.02-2.61；P=.04)，以及治疗强度的增加(B方案对A：OR，2.11[95%CI，1.24-3.60]；C方案对A：OR，1.41[95%CI，0.76-2.62]；P=0.02)。重要的是，唐氏综合征患者在维持期发生IRM的风险显著更高(P=.048)。我们的结果证实了唐氏综合征是IRM的主要危险因素。在高危人群和高危时期，应考虑加强支持性护理和预防性抗生素。这项研究在http://www.controlled-trials.com/注册为#ISRCTN07355119。
Although infection is the major cause of treatment-related mortality (TRM) in childhood acute lymphoblastic leukemia, factors associated with infection-related mortality (IRM) are poorly understood. To address this, we report an analysis of all 75 cases of IRM in the United Kingdom Childhood Acute Lymphoblastic Leukaemia Randomised Trial 2003 (UKALL 2003). The 5-year cumulative incidence of IRM was 2.4% (95% confidence interval [CI], 1.9%-3.0%), accounting for 75 (30%) of 249 trial deaths and 75 (64%) of 117 TRM deaths. Risk for IRM as a proportion of TRM was greater in induction than other phases (77% vs 56%; P = .02). Sixty-eight percent of cases were associated with bacterial infection (64% Gram-negative) and 20% with fungal infection. Down syndrome was the most significant risk factor for IRM(odds ratio [OR], 12.08; 95% CI, 6.54-22.32; P < .0001). In addition, there was a trend toward increased IRM in girls (OR, 1.63; 95% CI, 1.02-2.61; P = .04), as well as increasing treatment intensity (regimen B vs A: OR, 2.11 [95% CI, 1.24-3.60]; regimen C vs A: OR, 1.41 [95% CI, 0.76-2.62]; P = .02). Importantly, patients with Down syndrome were at significantly higher risk for IRM during maintenance (P = .048). Our results confirm Down syndrome as a major risk factor for IRM. Enhanced supportive care and prophylactic antibiotics should be considered in high-risk patient groups and during periods of increased risk. This study was registered at http://www.controlled-trials.com/ as #ISRCTN07355119.