Infectious complications in children with acute myeloid leukemia: decreased mortality in multicenter trial
Infectious complications in children with acute myeloid leukemia: decreased mortality in multicenter trial
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DOI：
10.1038/bcj.2015.110
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发表时间：
2016-01-01
影响因子：
12.8
通讯作者：
Lehrnbecher, T.
中科院分区：
文献类型：
--
作者：
Bochennek, K.;Hassler, A.;Lehrnbecher, T.
感染是儿童急性髓细胞白血病（AML）发病和死亡的重要原因。因此，我们根据试验AML-BFM 2004描述了接受治疗的儿童的感染性并发症。唐氏综合征患者被排除在分析之外。数据是从患者接受治疗的医院的医疗记录中收集的。共有405名患者（203名女孩;中位年龄8.4岁）经历了1326例感染。不明原因发热占56.1%，临床和微生物感染分别占17.5%和32.4%。总共从血流中回收了240株革兰氏阳性（112株草绿色链球菌）和90株革兰氏阴性分离株。3%的患者诊断为侵袭性真菌感染。三名儿童分别死于革兰氏阴性菌血症和侵袭性曲霉病。与剂量强度较低的AML-BFM 93的结果相比，2004年AML-BFM的感染相关发病率略高（3.3。与每例患者2.8例感染相比），而感染相关死亡率显著降低（1.5%与5.4%; P = 0.003）。治疗方案中包含的具体抗感染建议，儿科血液学家的定期培训课程以及经验的增加可能是AML儿童感染相关死亡率降低的原因。需要进一步的研究来降低感染相关的发病率。
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.