Lex C, Körholz D, Kohlmüller B, Bönig H, Willers R, Kramm C M, Göbel U
Department of Pediatric Hematology and Oncology, Children's Hospital, Heinrich Heine University of Düsseldorf, Germany.
Support Care Cancer. 2001 Oct;9(7):514-21. doi: 10.1007/s005200100248.
Infections still remain a major cause of therapy-associated morbidity and death in patients with malignant diseases. To further lower the risk of serious and long-lasting infections by additional supportive measures, detailed information on the frequency and characteristic features of infections is needed. Therefore, patient data from 112 children with acute lymphoblastic leukemia and T-cell lymphoma who were treated according to the COALL-05-92 protocol in our department were analyzed for differences in the frequency and origin of febrile episodes in relation to age, immunological type of leukemia, treatment in group assessed as being at high or low risk of relapse, actual occurrence of relapse, and course of chemotherapy. At the time of diagnosis, low-risk patients more commonly presented with febrile episodes than high-risk patients. In total, patients developed a fever in 313 (24%) of 1,307 evaluated chemotherapy cycles. Febrile episodes were associated with microbiologically or clinically documented infections in 60% of all cases, while in 40% the fever was of unknown origin. Gram-positive pathogens had a markedly higher incidence than gram-negative or fungal ones. The incidence of febrile episodes during therapy appeared to be correlated with certain chemotherapeutic drug combinations. The highest rate was found after high-dose cytarabine and asparaginase causing a long period of leukopenia. However, after other chemotherapy courses with a similar duration of leukopenia the incidence of febrile episodes was significantly lower, suggesting that specific interactions of different chemotherapeutic agents with the immune response might be an important factor in development of infections. Individual factors might also account for an increased incidence of infections, since the number of high-risk patients with recurrent infections was significantly higher than expected on the basis of statistical evaluation. In conclusion, our findings suggest that the risk of infections during chemotherapy may not only be influenced by leukopenia, but that drug-specific effects of the various chemotherapeutic agents and individual factors may also be important contributory factors. These observations must be further expanded in prospective studies so that new tailored supportive care protocols can be elaborated.
感染仍是恶性疾病患者治疗相关发病和死亡的主要原因。为了通过额外的支持措施进一步降低严重和长期感染的风险，需要有关感染频率和特征的详细信息。因此，我们分析了在我科按照COALL - 05 - 92方案治疗的112例急性淋巴细胞白血病和T细胞淋巴瘤儿童患者的数据，以探讨发热发作频率和来源在年龄、白血病免疫类型、评估为高或低复发风险组的治疗、实际复发情况以及化疗过程方面的差异。在诊断时，低风险患者比高风险患者更常出现发热发作。在总共1307个评估的化疗周期中，患者有313次（24%）出现发热。在所有病例中，60%的发热发作与微生物学或临床记录的感染相关，而40%的发热原因不明。革兰氏阳性病原体的发生率明显高于革兰氏阴性或真菌病原体。治疗期间发热发作的发生率似乎与某些化疗药物组合相关。在高剂量阿糖胞苷和天冬酰胺酶导致长时间白细胞减少后发生率最高。然而，在其他白细胞减少持续时间相似的化疗疗程后，发热发作的发生率显著较低，这表明不同化疗药物与免疫反应的特定相互作用可能是感染发生的一个重要因素。个体因素也可能导致感染发生率增加，因为反复感染的高风险患者数量明显高于基于统计评估预期的数量。总之，我们的研究结果表明，化疗期间感染的风险可能不仅受白细胞减少的影响，而且各种化疗药物的药物特异性作用和个体因素也可能是重要的促成因素。这些观察结果必须在前瞻性研究中进一步扩展，以便制定新的量身定制的支持性护理方案。
