Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital New York, New York.
Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Pediatr Blood Cancer. 2018 May;65(5):e26952. doi: 10.1002/pbc.26952. Epub 2018 Jan 10.
Pediatric patients receiving induction chemotherapy for newly diagnosed acute lymphoblastic leukemia (ALL) are at high risk of developing life-threatening infections. We investigated whether uniform antibacterial guidelines, including mandatory antibacterial prophylaxis in afebrile patients during induction, decreases the incidence of microbiologically documented bacteremia.
Between 2012 and 2015, 230 patients with newly diagnosed ALL (aged 1-21) were enrolled on Dana-Farber Cancer Institute ALL Consortium Protocol 11-001 (DFCI 11-001). Induction therapy, regardless of risk group, included vincristine, prednisone, doxorubicin, methotrexate, and PEG-asparaginase. Afebrile patients received fluoroquinolone prophylaxis at the initiation of induction and those presenting with fever received broad-spectrum antibiotics; antibiotics were continued until blood count recovery. Rates of documented bacteremias and fungal infections on DFCI 11-001 were compared to those on the predecessor protocol (DFCI 05-001), which included the same induction phase without antibiotic prophylaxis guidelines.
Sixty-six (28.7%) patients received fluoroquinolone prophylaxis, the remaining patients received broad-spectrum antibiotics. Twenty-four (36.4%) patients on prophylaxis developed fever and seven (10.6%) developed bacteremia. The overall rate of infection during induction on DFCI 11-001 was lower than on DFCl 05-001 (14.3% vs. 26.3%, P < 0.0001) due to a decreased rate of bacteremia (10.9% vs. 24.4%, P < 0.0001). The rate of fungal infections (4.8% vs. 3.6%) and induction death (0.9% vs. 2%) was not significantly different.
For children with newly diagnosed ALL, uniform antibiotic administration until blood count recovery, including fluoroquinolone prophylaxis for afebrile patients, reduced the incidence of bacteremia during the induction phase. Larger, randomized studies should be performed to confirm these findings.
接受新诊断的急性淋巴细胞白血病（ALL）诱导化疗的儿科患者有发生危及生命的感染的高风险。我们研究了是否统一的抗菌指南，包括在诱导期间对无发热患者进行强制性抗菌预防，是否会降低微生物学证实的菌血症的发生率。
在 2012 年至 2015 年期间，230 名新诊断为 ALL（年龄 1-21 岁）的患者参加了达纳-法伯癌症研究所 ALL 联盟方案 11-001（DFCI 11-001）。无论风险组如何，诱导治疗均包括长春新碱、泼尼松、多柔比星、甲氨蝶呤和 PEG 天冬酰胺酶。无发热的患者在诱导开始时接受氟喹诺酮预防，出现发热的患者接受广谱抗生素治疗；抗生素一直持续到血象恢复。在 DFCI 11-001 上记录的菌血症和真菌感染的发生率与前一个方案（DFCI 05-001）进行了比较，该方案包括相同的诱导阶段，没有抗生素预防指南。
66 名（28.7%）患者接受了氟喹诺酮预防，其余患者接受了广谱抗生素治疗。在接受预防的 66 名患者中，24 名（36.4%）出现发热，7 名（10.6%）出现菌血症。在 DFCI 11-001 上，由于菌血症发生率降低（10.9% vs. 24.4%，P < 0.0001），诱导期间感染的总体发生率低于 DFCI 05-001（14.3% vs. 26.3%，P < 0.0001）。真菌感染率（4.8% vs. 3.6%）和诱导死亡率（0.9% vs. 2%）无显著差异。
对于新诊断的 ALL 儿童，在血象恢复前使用统一的抗生素治疗，包括对无发热患者使用氟喹诺酮预防，可降低诱导期菌血症的发生率。应进行更大规模的随机研究来证实这些发现。
