Infections and Association With Different Intensity of Chemotherapy in Children With Acute Myeloid Leukemia

Cancer (Impact Factor: 4.89). 03/2009; 115(5):1100 - 1108. DOI: 10.1002/cncr.24107


BACKGROUND:The objectives were to compare infections during different intensities of therapy in children with acute myeloid leukemia (AML).METHODS:Subjects were children enrolled in Children's Cancer Group 2891 with AML. In phase 1 (induction), patients were randomized to intensive or standard timing. In phase 2 (consolidation), those with a family donor were allocated allogeneic stem cell transplantation (SCT); the remainder were randomized to autologous SCT or chemotherapy. This report compares infections between different treatments on an intent-to-treat basis.RESULTS:During phase 1, intensive timing was associated with more bacterial (57.7% vs 39.4%; P < .001), fungal (27.4% vs 9.9%; P < .001), and viral (14.0% vs 3.9%; P < .001) infections compared with standard timing. During phase 2, chemotherapy was associated with more bacterial (56.5% vs 40.1%; P = .005), but similar fungal (9.5% vs 6.1%; P = 1.000) and viral (4.2% vs 12.9%; P = .728) infections compared with allogeneic SCT. No differences between chemotherapy and autologous SCT infections were seen. Fatal infections were more common during intensive compared with standard timing induction (5.5% vs 0.9%; P = .004). Infectious deaths were similar between chemotherapy, autologous SCT, and allogeneic SCT.CONCLUSIONS:Prevalence of infection varies depending on the intensity and type of treatment. This information sheds insight into the mechanisms behind susceptibility and outcome of infections in pediatric AML. Cancer 2009. © 2009 American Cancer Society.

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    • "CD8 + memory T cells are required to control reactivations of cytomegalovirus (CMV) and Epstein Barr virus (EBV) (Smets et al., 2002; Walter et al., 1995). Patients with acute myeloid leukemia (AML) receive repeated cycles of chemotherapy that induce severe but transient lymphocytopenia, yet rarely develop clinical infection with CMV or EBV either during the lymphocyte nadir or after recovery of lymphocyte numbers (Sung et al., 2009). The absence of infection in AML patients undergoing chemotherapy suggests that sufficient virus-specific memory T cells survive chemotherapy and reconstitute functional, long-lived immunity thereafter. "
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