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Arch Hellen Med, 26(3), May-June 2009, 366-373


Infections in pediatric patients with acute lymphoblastic leukemia during the entire course of treatment

1Department of Pediatric Hematology-Oncology,
2Department of Microbiology,"Aghia Sophia" Children's Hospital, Athens, Greece

OBJECTIVE To assess the type, frequency, severity and outcome of all infectious episodes in a cohort of pediatric patients with acute lymphoblastic leukemia (ALL), during the entire course of leukemia treatment.

METHOD Eighty six patients diagnosed with ALL, during the period 4/1994-2/2000 in a Pediatric Hematology-Oncology unit were enrolled in the study. The patients were treated according to a modified ALL-BFM protocol. Retrospective analysis was made of all types of infections, according to the treatment phase and the degree of neutropenia.

RESULTS A total of 610 infectious episodes were recorded, most of which (57%) were documented during maintenance. Of the 347 episodes encountered during maintenance, the commonest diagnosis (40%) was non-specific viral upper respiratory tract infection (URI). Furthermore, 38 of 58 total specific viral infections occurred during maintenance: Sixteen herpes simplex, 7 varicella and 10 herpes zoster (VZV). During induction 123 infections (20.3%) were documented, with bacteremia (n=29) and episodes of fever of unknown origin (FUO) (n=28) being the commonest infectious episodes. The number of cases of Gram (-) bacteremia was 50% (26/52). The majority of the infections (59.5%) occurred in the absence of neutropenia (absolute neutrophil count, ANC >1.0 K/μL). Fewer infections (9.3%) were recorded with concurrent very severe neutropenia (ANC <0.1 K/μL), although 38.5% of positive blood cultures were documented with severe neutropenia. Infection related fatality was negligible.

CONCLUSIONS Most of the severe infections occurred during the induction phase of ALL treatment. Gram (+) and Gram (-) bacteremia were observed in almost equal proportions. URIs were the commonest infections during the entire treatment and during maintenance. Specific viral infections represented a smaller percentage of the total; VZV was the commonest pathogen. Infectious complications represented a significant morbidity factor during ALL treatment, but notably, mortality was negligible.

Key words: Acute lymphoblastic leukemia, Childhood, Infections, Neutropenia.

© Archives of Hellenic Medicine