Li Meng-Ju, Chang Hsiu-Hao, Yang Yung-Li, Lu Meng-Yao, Shao Pei-Lan, Fu Chun-Min, Chou An-Kuo, Liu Yen-Lin, Lin Kai-Hsin, Huang Li-Min, Lin Dong-Tsamn, Jou Shiann-Tarng
Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Pediatr Blood Cancer. 2017 Oct;64(10). doi: 10.1002/pbc.26535. Epub 2017 Apr 1.
Infection is a major complication in pediatric patients with acute lymphoblastic leukemia during chemotherapy. In this study, the infection characteristics were determined and risk factors analyzed based on the Taiwan Pediatric Oncology Group (TPOG) acute lymphoblastic leukemia (ALL) protocol.
We retrospectively reviewed fever events during chemotherapy in 252 patients treated during two consecutive clinical trials at a single institution between 1997 and 2012. Patients were classified as standard, high, and very high risk by treatment regimen according to the TPOG definitions. We analyzed the characteristics and risk factors for infection.
Fever occurred in 219 patients (86.9%) with a mean of 2.74 episodes per person. The fever events comprised 64% febrile neutropenia, 39% clinically documented infections, and 44% microbiologically documented infections. The microbiologically documented infections were mostly noted during the induction phase and increased in very high risk patients (89 vs. 24% and 46% in standard-risk and high-risk patients, respectively). Younger age and higher risk (high-risk and very high risk groups) were risk factors for fever and microbiologic and bloodstream infections. Female gender and obesity were additive risk factors for urinary tract infection (odds ratios = 3.52 and 3.24, P < 0.001 and P = 0.004, respectively).
Infections developed primarily during the induction phase, for which younger age and higher risk by treatment regimen were risk factors. Female gender and obesity were additive risk factors for urinary tract infection.
感染是小儿急性淋巴细胞白血病患者化疗期间的主要并发症。本研究基于台湾儿科肿瘤学组（TPOG）急性淋巴细胞白血病（ALL）方案，确定感染特征并分析危险因素。
我们回顾性分析了1997年至2012年间在单一机构进行的两项连续临床试验中接受治疗的252例患者化疗期间的发热事件。根据TPOG定义，患者按治疗方案分为标准风险、高风险和极高风险组。我们分析了感染的特征和危险因素。
219例患者（86.9%）出现发热，平均每人2.74次。发热事件包括64%的发热性中性粒细胞减少、39%的临床记录感染和44%的微生物学记录感染。微生物学记录感染大多在诱导期出现，且在极高风险患者中增加（标准风险和高风险患者分别为24%和46%，而极高风险患者为89%）。年龄较小和风险较高（高风险和极高风险组）是发热、微生物感染和血流感染的危险因素。女性和肥胖是尿路感染的附加危险因素（优势比分别为3.52和3.24，P<0.001和P = 0.004）。
感染主要发生在诱导期，年龄较小和治疗方案风险较高是其危险因素。女性和肥胖是尿路感染的附加危险因素。
