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Infectious Complications in Children With Acute Myeloid Leukemia and Down Syndrome: Analysis of the Prospective Multicenter Trial AML‐BFM 2004
Author(s) -
Hassler Angela,
Bochennek Konrad,
Gilfert Julia,
Perner Corinna,
Schöning Stefan,
Creutzig Ursula,
Reinhardt Dirk,
Lehrnbecher Thomas
Publication year - 2016
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.25917
Subject(s) - medicine , bacteremia , pneumonia , myeloid leukemia , leukemia , fever of unknown origin , regimen , antibiotics , prospective cohort study , pediatrics , immunology , microbiology and biotechnology , biology
Background Children with acute myeloid leukemia (AML) and Down syndrome have high survival rates with intensity‐reduced chemotherapeutic regimens, although the optimal balance between dose intensity and treatment toxicity has not been determined. We, therefore, characterized infectious complications in children with AML and Down syndrome treated according to AML‐BFM 2004 study (ClinicalTrials.gov NCT00111345; amended 2006 for Down syndrome with reduced intensity). Procedure Data on infectious complications were gathered from the medical records in the hospital where the patient was treated. Infectious complications were categorized as fever without identifiable source (FUO), or as microbiologically or clinically documented infections. Results A total of 157 infections occurred in 61 patients (60.5% FUO, 9.6% and 29.9% clinically and microbiologically documented infections, respectively). Almost 90% of the pathogens isolated from the bloodstream were Gram‐positive bacteria, and approximately half of them were viridans group streptococci. All seven microbiologically documented episodes of pneumonia were caused by viruses. Infection‐related mortality was 4.9%, and all three patients died due to viral infection. Conclusions Our data demonstrate that a reduced‐intensity chemotherapeutic regimen in children with AML and Down syndrome is still associated with high morbidity. Although no patient died due to bacteria or fungi, viruses were responsible for all lethal events. Future studies, therefore, have to focus on the impact of viruses on morbidity and mortality of patients with AML and Down syndrome.