Infections and association with different intensity of chemotherapy in children with acute myeloid leukemia.

Abstract

BACKGROUND:

The objectives were to compare infections during different intensities of therapy in children with acute myeloid leukemia (AML).

METHODS:

Subjects were children enrolled in Children's Cancer Group 2891 with AML. In phase 1 (induction), patients were randomized to intensive or standard timing. In phase 2 (consolidation), those with a family donor were allocated allogeneic stem cell transplantation (SCT); the remainder were randomized to autologous SCT or chemotherapy. This report compares infections between different treatments on an intent-to-treat basis.

RESULTS:

During phase 1, intensive timing was associated with more bacterial (57.7% vs 39.4%; P < .001), fungal (27.4% vs 9.9%; P < .001), and viral (14.0% vs 3.9%; P < .001) infections compared with standard timing. During phase 2, chemotherapy was associated with more bacterial (56.5% vs 40.1%; P = .005), but similar fungal (9.5% vs 6.1%; P = 1.000) and viral (4.2% vs 12.9%; P = .728) infections compared with allogeneic SCT. No differences between chemotherapy and autologous SCT infections were seen. Fatal infections were more common during intensive compared with standard timing induction (5.5% vs 0.9%; P = .004). Infectious deaths were similar between chemotherapy, autologous SCT, and allogeneic SCT.

CONCLUSIONS:

Prevalence of infection varies depending on the intensity and type of treatment. This information sheds insight into the mechanisms behind susceptibility and outcome of infections in pediatric AML.

• Authors: Lillian Sung, Alan Gamis, Todd A Alonzo, Allen Buxton, Kristen Britton, Joetta Deswarte-Wallace, William G Woods
• Journal: Cancer (Cancer) Vol. 115 Issue 5 Pg. 1100-8 (Mar 01 2009) ISSN: 0008-543X [Print] United States
• PMID: 19156894 (Publication Type: Clinical Trial, Phase I, Clinical Trial, Phase II, Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural)
• Copyright: (c) 2009 American Cancer Society.

Topics

• Adolescent
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects)
• Bacterial Infections (complications, mortality)
• Child
• Child, Preschool
• Humans
• Infections (complications, mortality)
• Leukemia, Myeloid, Acute (complications, drug therapy)
• Mycoses (complications, mortality)
• Stem Cell Transplantation (adverse effects)
• Virus Diseases (complications, mortality)