Sung Lillian, Buxton Allen, Gamis Alan, Woods William G, Alonzo Todd A
Department of Paediatrics and Program in Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada.
J Pediatr Hematol Oncol. 2012 Jan;34(1):e30-5. doi: 10.1097/MPH.0b013e31822817a6.
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.
为了确定在急性髓系白血病患儿中，危及生命或致命感染的比例是否因诱导治疗强度或强化治疗类型而异。研究对象为参加儿童癌症组（CCG）2891研究的初发急性髓系白血病患儿。在第1阶段（诱导期），患者被随机分配接受4个周期的化疗，化疗给药时间分为强化或标准时间。在第2阶段（强化期），缓解的患者若有合适的家庭供者则接受异基因干细胞移植（SCT），其余患者则随机接受自体SCT或化疗。每种感染均被前瞻性地分类为非危及生命、危及生命或致命。与标准时间诱导相比，强化时间诱导时被认为危及生命或致命的所有感染的比例更高（60.3%对37.3%，P<0.0001）。与标准时间诱导相比，强化时间诱导时由革兰氏阳性菌、革兰氏阴性菌和真菌引起的感染明显更可能严重。大多数霉菌感染是危及生命或致命的。与SCT相比，化疗强化与不那么严重的感染无关。与标准时间诱导相比，强化时间诱导与更严重的感染相关。对于强化诱导方案，预防策略可能更为重要。
