Zengin Emine, Sarper Nazan, Aylan Gelen Sema, Demirsoy Uğur, Karadoğan Meriban, Çakı Kılıç Suar, Öncel Selim, Arısoy Emin Sami, Dündar Devrim
Kocaeli University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Kocaeli, Turkey.
Kocaeli University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Kocaeli, Turkey.
Turk J Haematol. 2017 Dec 1;34(4):340-344. doi: 10.4274/tjh.2017.0052. Epub 2017 Mar 29.
This study aimed to evaluate infection-related mortality in patients with acute myeloid leukemia (AML) treated without preventive antibiotics and antifungals in a middle-income country.
Infection-related mortality was evaluated retrospectively in 49 pediatric patients.
A total of 173 chemotherapy courses were administered as first-line chemotherapy. Four patients died during induction: one patient due to intracranial bleeding, two patients due to typhlitis, and one patient due to invasive fungal infection with pulmonary vascular invasion and massive bleeding. Another two patients died with resistant disease. During consolidation there were four infection-related deaths and one death due to cardiotoxicity. In first-line chemotherapy mortality was 22% (11/49); infection-related mortality was 14% (7/49). Event-free survival and overall survival at 6 years were 42.9% and 61.2% (95% CI: 44-76 and 66-99 months), respectively.
Due to considerable infection-related deaths, antibacterial and mold-active antifungal prophylaxis may be tried during neutropenic periods in pediatric AML.
本研究旨在评估在一个中等收入国家中，未经预防性使用抗生素和抗真菌药物治疗的急性髓系白血病（AML）患者的感染相关死亡率。
对49例儿科患者的感染相关死亡率进行回顾性评估。
共进行了173个疗程的一线化疗。诱导期有4例患者死亡：1例死于颅内出血，2例死于盲肠炎，1例死于侵袭性真菌感染伴肺血管侵袭和大量出血。另外2例患者死于耐药性疾病。巩固期有4例感染相关死亡，1例死于心脏毒性。一线化疗的死亡率为22%（11/49）；感染相关死亡率为14%（7/49）。6年时的无事件生存率和总生存率分别为42.9%和61.2%（95%CI：44 - 76个月和66 - 99个月）。
由于存在相当数量的感染相关死亡病例，对于儿童AML患者，在中性粒细胞减少期可尝试进行抗菌和抗霉菌活性的抗真菌预防。
