Infectious Events Prior to Chemotherapy Initiation in Children with Acute Myeloid Leukemia

Carol Portwine,Josee Brossard,Rochelle Yanofsky,Victor Lewis,David Dix,Sonia Cellot,Victoria Price,Marie-Chantal Ethier,Shayna Zelcer,Lillian Sung,Joseph Beyene,Mariana Silva,Biljana Gillmeister,Bruno Michon,Kent Stobart,Donna Johnston,Lynette Bowes,David Mitchell,Ray Borrow

doi:10.1371/journal.pone.0061899

Abstract

BackgroundThe primary objective was to describe infectious complications in children with acute myeloid leukemia from presentation to the healthcare system to initiation of chemotherapy and to describe how these infections differ depending on neutropenia.MethodsWe conducted a retrospective, population-based cohort study that included children and adolescents with acute myeloid leukemia diagnosed and treated at 15 Canadian centers. We evaluated infections that occurred between presentation to the healthcare system (for symptoms that led to the diagnosis of acute myeloid leukemia) until initiation of chemotherapy.ResultsAmong 328 children, 92 (28.0%) were neutropenic at presentation. Eleven (3.4%) had sterile-site microbiologically documented infection and four had bacteremia (only one Gram negative). Infection rate was not influenced by neutropenia. No child died from an infectious cause prior to chemotherapy initiation.ConclusionIt may be reasonable to withhold empiric antibiotics in febrile non-neutropenic children with newly diagnosed acute myeloid leukemia until initiation of chemotherapy as long as they appear well without a clinical focus of infection. Future work could examine biomarkers or a clinical score to identify children presenting with leukemia and fever who are more likely to have an invasive infection.

Highlights

Children with acute myeloid leukemia (AML) receive intensive chemotherapy and during treatment, they are at substantial risk of morbidity and mortality from invasive infections.[1]
Outcome Measures We evaluated infections that occurred between presentation to the healthcare system until initiation of chemotherapy
Gender and age were not significantly associated with neutropenia at presentation whereas children with Down syndrome were significantly less likely to present with neutropenia

Summary

Introduction

Children with acute myeloid leukemia (AML) receive intensive chemotherapy and during treatment, they are at substantial risk of morbidity and mortality from invasive infections.[1]. Cancer-specific fever and neutropenia guidelines do not provide recommendations for this scenario since the setting for guidelines is usually restricted to patients who are receiving treatments for cancer.[2,4] it would be useful to know if infection outcomes differed depending on the presence or absence of neutropenia in this setting since the presence of neutropenia is a major criterion that influences the decision to start antibiotics in febrile children receiving treatment for cancer. The primary objective was to describe infectious complications in children with acute myeloid leukemia from presentation to the healthcare system to initiation of chemotherapy and to describe how these infections differ depending on neutropenia

Methods

Results

Conclusion