Abstract
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.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Creutzig U, Ritter J, Zimmermann M, Reinhardt D, Hermann J, Berthold F et al. Improved treatment results in high-risk pediatric acute myeloid leukemia patients after intensification with high-dose cytarabine and mitoxantrone: results of Study Acute Myeloid Leukemia–Berlin–Frankfurt–Munster 93. J Clin Oncol 2001; 19: 2705–2713.
Feusner JH, Hastings CA . Infections in children with acute myelogenous leukemia. Concepts of management and prevention. J Pediatr Hematol Oncol 1995; 17: 234–247.
Tobias JS, Wrigley PF, O'Grady F . Bacterial infection and acute myeloblastic leukaemia: an analysis of two hundred patients undergoing intensive remission induction therapy. Eur J Cancer 1978; 14: 383–391.
Madani TA . Clinical infections and bloodstream isolates associated with fever in patients undergoing chemotherapy for acute myeloid leukemia. Infection 2000; 28: 367–373.
Wisplinghoff H, Seifert H, Wenzel RP, Edmond MB . Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematological malignancies and solid neoplasms in hospitals in the United States. Clin Infect Dis 2003; 36: 1103–1110.
Ascioglu S, Rex JH, de Pauw B, Bennett JE, Bille J, Crokaert F et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 2002; 34: 7–14.
Creutzig U, Ritter J, Zimmermann M, Hermann J, Gadner H, Blütters-Sawatzki D et al. Idarubicin improves blast cell clearance during induction therapy in children with AML: results of study AML-BFM 93. AML-BFM Study Group. Leukemia 2001; 15: 348–354.
Creutzig U, Ritter J, Vormoor J, Ludwig WD, Niemeyer C, Reinisch I et al. Myelodysplasia and acute myelogenous leukemia in Down's syndrome. A report of 40 children of the AML-BFM Study Group. Leukemia 1996; 10: 1677–1686.
Auletta JJ, O'Riordan MA, Nieder ML . Infections in children with cancer: a continued need for the comprehensive physical examination. J Pediatr Hematol Oncol 1999; 21: 501–508.
Riley LC, Hann IM, Wheatley K, Stevens RF . Treatment-related deaths during induction and first remission of acute myeloid leukaemia in children treated on the Tenth Medical Research Council acute myeloid leukaemia trial (MRC AML10). The MCR Childhood Leukaemia Working Party. Br J Haematol 1999; 106: 436–444.
Pizzo PA, Robichaud KJ, Wesley R, Commers JR . Fever in the pediatric and young adult patient with cancer. A prospective study of 1001 episodes. Medicine (Baltimore) 1982; 61: 153–165.
Lehrnbecher T, Foster C, Vazquez N, Mackall CL, Chanock SJ . Therapy-induced alterations in host defense in children receiving chemotherapy. J Pediatr Hematol Oncol 1997; 19: 399–417.
Tunkel AR, Sepkowitz KA . Infections caused by viridans streptococci in patients with neutropenia. Clin Infect Dis 2002; 34: 1524–1529.
Cordonnier C, Buzyn A, Leverger G, Herbrecht R, Hunault M, for the Club de Réflexion sur les Infections en Onco-Hématologie et al. Epidemiology and risk factors for Gram-positive coccal infections in neutropenia: toward a more targeted antibiotic strategy. Clin Infect Dis 2003; 36: 149–158.
Rieske K, Handrick W, Spencker FB, Gunther E . Infection caused by viridans streptococci in children with malignant hematologic diseases. Klin Padiatr 1997; 209: 364–372.
Shenep JL . Viridans-group streptococcal infections in immunocompromised hosts. Int J Antimicrob Agents 2000; 14: 129–135.
Woods WG, Ruymann FB, Lampkin BC, Buckley JD, Bernstein ID, Srivastava AK et al. The role of timing of high-dose cytosine arabinoside intensification and of maintenance therapy in the treatment of children with acute nonlymphocytic leukemia. Cancer 1990; 66: 1106–1113.
Edmond MB, Wallace SE, McClish DK, Pfaller MA, Jones RN, Wenzel RP . Nosocomial bloodstream infections in United States hospitals: a three-year analysis. Clin Infect Dis 1999; 29: 239–244.
Ritter J, Roos N . Special aspects related to invasive fungal infections in children with cancer. In: F. Meunier (ed) Invasive Fungal Infections in Cancer Patients. London, Philadelphia, Sydney, Tokyo, Toronto: Balliere Tindall, 1995, pp 179–204.
Zubizarreta P, Felice MS, Alfaro E, Fraquelli L, Casak S, Quinteros R et al. Acute myelogenous leukemia in Down's syndrome: report of a single pediatric institution using a BFM treatment strategy. Leukemia Res 1998; 22: 465–472.
Taub JW, Stout ML, Buck SA, Huang X, Vega RA, Becton DL et al. Myeloblasts from Down syndrome children with acute myeloid leukemia have increased in vitro sensitivity to cytosine arabinoside and daunorubicin. Leukemia 1997; 11: 1594–1595.
Acknowledgements
This study was supported by the Deutsche Krebshilfe. We thank the medical and nursing staff of the participating centers. This work is dedicated to Professor Joachim Kühl†.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lehrnbecher, T., Varwig, D., Kaiser, J. et al. Infectious complications in pediatric acute myeloid leukemia: analysis of the prospective multi-institutional clinical trial AML-BFM 93. Leukemia 18, 72–77 (2004). https://doi.org/10.1038/sj.leu.2403188
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.leu.2403188
Keywords
This article is cited by
-
Clinical and biological aspects of myeloid leukemia in Down syndrome
Leukemia (2021)
-
Effectiveness and antimicrobial susceptibility profiles during primary antimicrobial prophylaxis for pediatric acute myeloid leukemia
Scientific Reports (2021)
-
Fieber während der Granulozytopenie bei krebskranken Kindern und Jugendlichen
Monatsschrift Kinderheilkunde (2021)
-
Which Type of Empiric Antibiotic Therapy is Appropriate? A 20-Year Retrospective Study of Bloodstream Infections in Childhood Cancer
Infectious Diseases and Therapy (2021)
-
Homoharringtonine is a safe and effective substitute for anthracyclines in children younger than 2 years old with acute myeloid leukemia
Frontiers of Medicine (2019)