Acute respiratory infections in children and adolescents with acute lymphoblastic leukemia
Acute respiratory infections in children and adolescents with acute lymphoblastic leukemia
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DOI：
10.1002/cncr.29833
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发表时间：
2016-03-01
期刊：
影响因子：
6.2
通讯作者：
Jeha, Sima
中科院分区：
文献类型：
--
作者：
Hakim, Hana;Dallas, Ronald;Jeha, Sima
研究背景关于急性淋巴细胞白血病（ALL）患儿呼吸道病毒感染的发病率、临床病程和影响的知识是有限的。方法对2007年至2011年期间在圣裘德儿童研究医院接受全面治疗XVI方案治疗的新诊断ALL患者进行回顾性队列研究。95例（43%）发生了133次病毒性急性呼吸道疾病（ARI）（发病率为1.1/1000患者-天）。在65例患者（29%）中确定了无病毒病因的ARI，在63例患者（28%）中未检测到ARI。种族、性别、年龄或ALL风险组与ARI的发生之间没有显著相关性。接受诱导化疗的儿童发生病毒性ARI的风险最高（发病率为2.3/1000患者-天）。流感病毒是最常见的病毒（38%），其次是呼吸道合胞病毒（33%）。在133例病毒性ARI中，61%的患者住院，26%的患者经历了复杂的病程，80%的患者化疗延迟，0.7%的患者死亡。24例患者（18%）发生病毒性下呼吸道感染（LRTI），其中5例（21%）发生并发症。病毒性下呼吸道感染患者淋巴细胞绝对计数的最低值明显较低;与病毒性上呼吸道感染者相比，更有可能感染呼吸道合胞病毒，住院治疗，化疗延迟时间更长。结论尽管ALL儿童中病毒性ARI的发病率较低，但相关的发病率，死亡率，和化疗延迟仍然具有临床意义。病毒性下呼吸道感染尤其与高发病率相关，需要加强护理水平的支持。Cancer 2016;122：798-805. (c)2015年美国癌症协会。目前的研究描述了急性淋巴细胞白血病儿童和青少年的回顾性队列中呼吸道病毒感染的发病率、临床病程和影响。确定了下呼吸道感染进展的危险因素和结局。
BACKGROUNDKnowledge regarding the incidence, clinical course, and impact of respiratory viral infections in children with acute lymphoblastic leukemia (ALL) is limited.METHODSA retrospective cohort of patients with newly diagnosed ALL who were treated on the Total Therapy XVI protocol at St Jude Children's Research Hospital between 2007 and 2011 was evaluated.RESULTSOf 223 children, 95 (43%) developed 133 episodes of viral acute respiratory illness (ARI) (incidence, 1.1 per 1000 patient-days). ARI without viral etiology was identified in 65 patients (29%) and no ARI was detected in 63 patients (28%). There were no significant associations noted between race, sex, age, or ALL risk group and the development of ARI. Children receiving induction chemotherapy were found to be at the highest risk of viral ARI (incidence, 2.3 per 1000 patient-days). Influenza virus was the most common virus (38%) followed by respiratory syncytial virus (33%). Of 133 episodes of viral ARI, 61% of patients were hospitalized, 26% experienced a complicated course, 80% had their chemotherapy delayed, and 0.7% of patients died. Twenty-four patients (18%) developed viral lower respiratory tract infections (LRTI), 5 of whom (21%) had complications. Patients with viral LRTI had a significantly lower nadir absolute lymphocyte count; were sicker at the time of presentation; and were more likely to have respiratory syncytial virus, to be hospitalized, and to have their chemotherapy delayed for longer compared with those with viral upper respiratory tract infections.CONCLUSIONSDespite the low incidence of viral ARI in children with ALL, the associated morbidity, mortality, and delay in chemotherapy remain clinically significant. Viral LRTI was especially associated with high morbidity requiring intensive care-level support. Cancer 2016;122:798-805. (c) 2015 American Cancer Society.The current study describes the incidence, clinical course, and impact of respiratory viral infections in a retrospective cohort of children and adolescents with acute lymphoblastic leukemia. Risk factors for and outcome of progression to lower respiratory tract infections were identified.