Life-threatening and fatal infections in children with acute myeloid leukemia: a report from the Children's Oncology Group.

Abstract

To determine among children with acute myeloid leukemia, whether the proportions of life-threatening or fatal infections differed according to the intensity of induction or type of intensification treatment. Participants were children enrolled to the Children's Cancer Group (CCG) 2891 with de novo acute myeloid leukemia. In phase 1 (induction) patients were randomized to 4 cycles of chemotherapy either administered as intensive or standard timing. In phase 2 (intensification), those achieving remission were allocated to allogeneic stem cell transplantation (SCT) if a suitable family donor was available while the remainder were randomized to autologous SCT or chemotherapy. Each infection was classified prospectively as nonlife-threatening, life-threatening, or fatal. The proportion of all infections that were considered life-threatening or fatal was higher with intensive timing compared with standard timing induction (60.3% vs. 37.3%, P<0.0001). Infections caused by Gram-positive and Gram-negative bacteria and fungi were significantly more likely to be severe during intensive compared with standard timing induction. Most molds were life-threatening or fatal. Chemotherapy intensification was not associated with less severe infections compared with SCT. Intensive timing was associated with more severe infections compared with standard timing induction. Prophylactic strategies are likely more important with intensive induction regimens.