Subscribe to RSS
DOI: 10.4103/ijmpo.ijmpo_95_17
Infections during Induction Chemotherapy in Children with Acute Lymphoblastic Leukemia – Profile and Outcomes: Experience from a Cancer Center in South India
Financial support and sponsorship Nil.
Abstract
Objective:The objective of this study is to describe the incidence, clinical, laboratory and microbiological profile, treatment, and outcome of infections during induction chemotherapy in children with acute lymphoblastic leukemia (ALL). Materials and Methods: This was prospective, observational study. All children aged 1–14 years, newly diagnosed to have ALL and attending the Pediatric oncology division at our center were included. Induction chemotherapy was administered as per a modified Berlin-Frankfurt-Münster protocol. The study period was from January 2014 to June 2015. Results: Two hundred and twenty-seven patients with ALL were included in the study. One hundred and fifty episodes of infection occurred among 117 patients. Major sites of infection were lung (n = 35) and gastrointestinal tract (n = 30). Blood cultures were positive in 45 episodes (30.6%) with Gram negative organisms being the predominant isolates. The most common organisms isolated were Pseudomonas aeruginosa and Klebsiella spp. The response to antibiotics was good with only 18% of episodes requiring a third-line antibiotic. One hundred and thirty-six (90.6%) episodes resolved without sequelae. Overall induction mortality (12 out of 227-5.3%) was mainly accounted for by infections. Conclusions: Infections are the major cause of mortality and morbidity in patients with ALL on induction chemotherapy. The outcomes are good for the majority of patients if they receive adequate antibiotics early in the course of infection.
Publication History
Article published online:
23 June 2021
© 2018. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Bakhshi S, Padmanjali KS, Arya LS. Infections in childhood acute lymphoblastic leukemia: An analysis of 222 febrile neutropenic episodes. Pediatr Hematol Oncol 2008; 25: 385-92
- 2 Sayed HA, El-Mahallawy HA, Kaddah AM, Ismael HT, Talaat SM. Profile of infections in newly diagnosed patients with acute leukemia during the induction phase of treatment. J Egypt Natl Canc Inst 2009; 21: 315-22
- 3 Vanderschueren S, De WeerdtA, Vankersschaever D, Frans E, Wilmer A. et al. Thrombocytopenia and prognosis in Intensive Care. Crit Care Med 2000; 28: 1871-6
- 4 Claushuis TA, van VughtLA, Scicluna BP, Wiewel MA, Klein KlouwenbergPM, Hoogendijk AJ. et al. Thrombocytopenia is associated with a dysregulated host response in critically ill sepsis patients. Blood 2016; 127: 3062-72
- 5 Radhakrishnan V, Vijaykumar V, Ganesan P, Rajendranath R, Trivadi G, Tenali S. et al. Bloodstream infections in pediatric patients at cancer institute, Chennai. Indian J Cancer 2014; 51: 418-9
- 6 Trehan A, Totadri S, Gautam V, Bansal D, Ray P. Invasive bacterial infections in a pediatric oncology unit in a tertiary care center. Indian J Cancer 2014; 51: 428-31
- 7 Bansal S, Advani SH. Pattern of bloodstream infections in patients with hematological malignancies in a tertiary care centre. Indian J Cancer 2014; 51: 447-9
- 8 Kapoor G, Sachdeva N, Jain S. Epidemiology of bacterial isolates among pediatric cancer patients from a tertiary care oncology center in North India. Indian J Cancer 2014; 51: 420-4
- 9 Thacker N, Pereira N, Banavali SD, Narula G, Vora T, Chinnaswamy G. et al. Epidemiology of blood stream infections in pediatric patients at a tertiary care cancer centre. Indian J Cancer 2014; 51: 438-41
- 10 Marwaha RK, Kulkarni KP, Bansal D, Trehan A. Pattern of mortality in childhood acute lymphoblastic leukemia: Experience from a single center in Northern India. J Pediatr Hematol Oncol 2010; 32: 366-9
- 11 O'Connor D, Bate J, Wade R, Clack R, Dhir S, Hough R. et al Infection-related mortality in children with acute lymphoblastic leukemia: An analysis of infectious deaths on UKALL2003. Blood 2014; 124: 1056-61
- 12 Rubnitz JE, Lensing S, Zhou Y, Sandlund JT, Razzouk BI, Ribeiro RC. et al. Death during induction therapy and first remission of acute leukemia in childhood: The St Jude experience. Cancer 2004; 101: 1677-84
- 13 Prucker C, Attarbaschi A, Peters C, Dworzak MN, Pötschger U, Urban C. et al Induction death and treatment-related mortality in first remission of children with acute lymphoblastic leukemia: A population-based analysis of the Austrian Berlin-Frankfurt-Münster Study Group. Leukemia 2009; 23: 1264-9
- 14 Christensen MS, Heyman M, HeyMöttönenman M, Zeller B, Jonmundsson G, Hasle H. et al Treatment-related death in childhood acute lymphoblastic Leukaemia in the Nordic countries: 1992-2001. Br J Haematol 2005; 131: 50-8