Effectiveness of supportive care measures to reduce infections in pediatric AML: a report from the Children's Oncology Group
Effectiveness of supportive care measures to reduce infections in pediatric AML: a report from the Children's Oncology Group
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DOI：
10.1182/blood-2013-01-476614
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发表时间：
2013-05-02
期刊：
影响因子：
20.3
通讯作者：
Gamis, Alan S.
中科院分区：
文献类型：
--
作者：
Sung, Lillian;Aplenc, Richard;Gamis, Alan S.
目的探讨抗生素和粒细胞集落刺激因子（G-CSF）预防和出院政策对急性髓系白血病（AML）患儿化疗期间感染风险和非复发相关死亡率（NRM）的影响。患者为入组儿童肿瘤组（COG）试验AAML 0531的非唐氏综合征儿童。我们调查了研究中心，以确定系统性抗细菌、抗真菌和G-CSF预防的机构标准，以及中性粒细胞减少症期间的强制住院治疗。COG机构调查回复率为180/216（83.3%）。在AAML 0531组入组的1024例患者中，897例是非唐氏症患者，来自调查应答机构。在多元回归分析中，预防性使用抗菌药物可减少任何不育部位细菌感染（发病率比[IRR] 0.85; 95%置信区间[CI]，0.72-1.01; P = .058）和革兰氏阳性不育部位感染（IRR 0.71; 95% CI，0.57-0.90; P = .004）。预防性G-CSF减少了细菌（IRR 0.79; 95% CI，0.67-0.92; P = .004）和艰难梭菌感染（CDIs; IRR 0.46; 95% CI，0.25-0.84; P = .012）。强制住院并没有减少细菌/真菌感染或显著减少NRM，但确实增加了CDI（IRR 1.96; 95% CI，1.34-2.87; P <0.001）。抗生素和G-CSF预防降低了感染率，而强制住院并没有减少感染或显著影响NRM。该试验在www.clinicaltrials.gov上注册为#AAML0531。
Objective was to describe the effect of antibiotic and granulocyte colony-stimulating factor (G-CSF) prophylaxis and discharge policy on infection risk and nonrelapse-related mortality (NRM) during chemotherapy for children with acute myeloid leukemia. Patients were non-Down syndrome children enrolled on Children's Oncology Group (COG) trial AAML0531. We surveyed sites to determine institutional standards for systemic antibacterial, antifungal, and G-CSF prophylaxis, and mandatory hospitalization during neutropenia. COG institution survey response rate was 180 of 216 (83.3%). Of 1024 patients enrolled on AAML0531, 897 were non-Down patients from survey-responding institutions. In multiple regression, antibacterial prophylaxis reduced any sterile-site bacterial infection (incidence rate ratio [IRR] 0.85; 95% confidence interval [CI], 0.72-1.01; P = .058) and Gram-positive sterile-site infection (IRR 0.71; 95% CI, 0.57-0.90; P = .004). Prophylactic G-CSF reduced bacterial (IRR 0.79; 95% CI, 0.67-0.92; P = .004) and Clostridium difficile infections (CDIs; IRR 0.46; 95% CI, 0.25-0.84; P = .012). Mandatory hospitalization did not reduce bacterial/fungal infection or significantly reduce NRM but did increase CDI (IRR 1.96; 95% CI, 1.34-2.87; P < .001). Antibacterial and G-CSF prophylaxis reduced infection rates while mandatory hospitalization did not reduce infection or significantly affect NRM. This trial was registered at www.clinicaltrials.gov as #AAML0531.