Castagnola Elio, Conte Massimo, Parodi Stefano, Papio Filippo, Caviglia Ilaria, Haupt Riccardo
Infectious Diseases Unit, G. Gaslini Children Hospital, Genoa, Italy.
Pediatr Blood Cancer. 2007 Oct 15;49(5):672-7. doi: 10.1002/pbc.21070.
Information on the incidence of infectious complications during for treatment for high risk neuroblastoma (HR-NB) is limited. Bacteremias and invasive mycoses may be considered surrogate markers of the infection burden.
Data on bacteremias and invasive mycoses occurring during 3 consecutive protocols for front line (NB-89; NB-92; NB-97) or salvage therapy (TVD) for HR-NB were reviewed. The cumulative risk of developing a first episode and the rate of infections during the entire length of each protocol were evaluated.
Front line protocols were given to 80 patients for a total of 22,070 days at risk; salvage treatment was given to 24 children for 2,909 days at risk. During front line therapy 41 infectious episodes were diagnosed in 29 (36%) patients, for a 45% cumulative risk and an infection rate (IR) of 0.19/100 patient-days-at risk. Salvage therapy determined five infectious episodes in four (17%) patients, with a 39% cumulative risk, and an IR of 0.17. The IR during the phase of high dose chemotherapy with hematopoietic stem cell rescue (megatherapy) included in the three front line protocols decreased over time (1.54 in NB-89; 0.52 in NB-92 and 0.0 in NB 97; P = 0.001), possibly because of the use of less aggressive conditioning regimens, without radiotherapy.
The IRs of protocols for HR-NB did not change over time. The megatherapy-related phases are those at highest risk.
关于高危神经母细胞瘤（HR-NB）治疗期间感染并发症发生率的信息有限。菌血症和侵袭性真菌病可被视为感染负担的替代标志物。
回顾了在HR-NB一线治疗（NB-89；NB-92；NB-97）或挽救治疗（TVD）的3个连续方案期间发生的菌血症和侵袭性真菌病的数据。评估了首次发作的累积风险以及每个方案整个疗程中的感染率。
80例患者接受了一线方案治疗，总计22070天的风险期；24例儿童接受了挽救治疗，2909天的风险期。在一线治疗期间，29例（36%）患者诊断出41次感染发作，累积风险为45%，感染率（IR）为0.19/100患者-日-风险。挽救治疗在4例（17%）患者中确定了5次感染发作，累积风险为39%，IR为0.17。三个一线方案中包含的造血干细胞救援大剂量化疗（超大剂量疗法）阶段的IR随时间下降（NB-89中为1.54；NB-92中为0.52；NB-97中为0.0；P = 0.001），可能是因为使用了攻击性较小的预处理方案，且未进行放疗。
HR-NB方案的IR并未随时间变化。超大剂量疗法相关阶段是风险最高的阶段。
