Infectious complications in pediatric acute myeloid leukemia: analysis of the prospective multi-institutional clinical trial AML-BFM 93
Infectious complications in pediatric acute myeloid leukemia: analysis of the prospective multi-institutional clinical trial AML-BFM 93
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DOI：
10.1038/sj.leu.2403188
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发表时间：
2004-01-01
期刊：
影响因子：
11.4
通讯作者：
Creutzig, U
中科院分区：
文献类型：
--
作者：
Lehrnbecher, T;Varwig, D;Creutzig, U
感染仍然是急性髓性白血病（AML）患儿治疗相关发病率和死亡率的主要原因。为了改进支持性护理措施，需要关于感染并发症的频率和特征的详细信息。我们根据多机构临床试验AML-BFM 93对30家医院304例患儿的病历进行回顾性分析。总体而言，304例患者发生了855例感染性并发症（不明来源发热（n=523, 61.2%）、临床感染（n=57, 6.7%）和微生物学记录感染（n=275, 32.1%））。74.1%的感染期出现中性粒细胞减少。总共有20例患者死于感染相关并发症(无唐氏综合征患者15/276(5.4%)，有唐氏综合征患者5/28(17.9%))，其中大多数死于早期诱导治疗（n=11）。228例发生血流感染（革兰氏阳性病原体202例，革兰氏阴性病原体42例）。15例患者可能或证实有侵袭性真菌感染。在855例感染病例中，有113例（13.3%）被放射学诊断为肺炎。更好的支持治疗策略可能有助于提高急性髓性白血病化疗儿童的总生存率。因此，AML患儿应在专门的儿科中心进行治疗，再入院患者的门槛应该很低，特别是有肺部症状的患者。
Infections still remain a major cause of therapy-associated morbidity and mortality in children with acute myeloid leukemia (AML). To improve supportive care measurements, detailed information on frequency and characteristic features of infectious complications is needed. We retrospectively analyzed the medical charts of 304 children, treated in 30 hospitals according to the multi-institutional clinical trial AML-BFM 93. Overall, 855 infectious complications occurred in 304 patients (fever without identifiable source (n=523; 61.2%), clinically (n=57; 6.7%) and microbiologically documented infections (n=275; 32.1%)). Neutropenia was present in 74.1% of the infectious episodes. In all, 20 patients died of infection-associated complications (15/276 (5.4%) patients without and 5/28 (17.9%) with Down syndrome), most of them during early induction therapy (n=11). Blood stream infections occurred in 228 episodes (Gram-positive (n=202) and Gram-negative (n=42) pathogens). Invasive fungal infection was probable or proven in 15 patients. In 113 out of the 855 infectious episodes (13.3%), pneumonia was radiologically diagnosed. Better strategies of supportive care might help to improve overall survival in children undergoing chemotherapy for AML. Therefore, children with AML should be treated in specialized pediatric centers, and there should be a very low threshold to readmit patients, in particular patients with pulmonary symptoms.