Analysis of Infectious Complications in Infants With Acute Lymphoblastic Leukemia Treated on the Children's Cancer Group Protocol 1953 A Report From the Children's Oncology Group
Analysis of Infectious Complications in Infants With Acute Lymphoblastic Leukemia Treated on the Children's Cancer Group Protocol 1953 A Report From the Children's Oncology Group
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DOI：
10.1097/mph.0b013e3181a6dec0
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发表时间：
2009-06-01
影响因子：
1.2
通讯作者：
Reaman, Gregory H.
中科院分区：
文献类型：
--
作者：
Salzer, Wanda;Dinndorf, Patricia;Reaman, Gregory H.
患有急性淋巴细胞白血病的婴儿预后很差。儿童癌症组（CCG）1953年方案检验了强化治疗将改善这些患者结局的假设。这种强化治疗导致更好的疾病控制，但导致更大的毒性。在本文中，我们报告了与这种强化治疗相关的感染并发症。我们回顾性分析了CCG 1953入选的所有115例患者的病例报告表上报告的感染并发症。在115例患者中共发现495例感染并发症。细菌感染最常见（74%），其次是病毒（13%），真菌（11%）和原生动物（1%）。感染相关死亡率与病毒（31%）和真菌（19%）感染不成比例。23%（n = 26）的患者死于感染性并发症，大多数发生在诱导/强化治疗期间。下呼吸道感染导致12例患者死亡，最常见的是病毒（n = 6）和真菌（n = 3）。与以前的研究相比，强化治疗导致感染并发症和死亡增加。未来的研究将需要关注：（1）在治疗的第一个月减少强化，（2）开发靶向治疗，（3）改进旨在预防，快速诊断和适当治疗感染的措施。
Infants with acute lymphoblastic leukemia have a poor prognosis. The Children's Cancer Group (CCG) 1953 protocol tested the hypothesis that intensification of therapy would improve outcome for these patients. This intensified therapy resulted in better disease control, but resulted in greater toxicity. In this paper, we report the infectious complications associated with this intensified therapy. We retrospectively analyzed the infectious complications reported on the case report forms of all 115 patients enrolled on CCG 1953. Overall 495 infectious complications were identified in 115 patients. Bacterial infections occurred most frequently (74%), followed by viral (13%), fungal (11%), and protozoan (1%). Infection related mortality disproportionately occurred with viral (31%) and fungal (19%) infections. Twenty-three percent (n = 26) of patients died of infectious complications, with the majority occurring during induction/intensification. Lower respiratory infections contributed to death in 12 patients and were most commonly viral (n = 6) and fungal (n = 3). Intensification of therapy resulted in increased infectious complications and deaths compared with previous studies. Future studies will need to focus on: (1) decreasing intensification during the first month of therapy, (2) developing targeted therapies, and (3) improving measures designed to prevent, quickly diagnose, and appropriately treat infections.