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Infections in a pediatric patient cohort with acute lymphoblastic leukemia during the entire course of treatment

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Abstract

Goals

To assess the type, frequency, severity, and outcome of all infectious episodes in a pediatric patient cohort with acute lymphoblastic leukemia (ALL) from a single institution during the entire length of leukemia treatment.

Patients and methods

Eighty-six patients were treated according to a modified ALL Berlin–Frankfurt–Munster protocol. Retrospective analysis of all types of infections according to the treatment phase and the degree of neutropenia is presented.

Results

A total of 610 infectious episodes were recorded. Most infections were documented during maintenance (57%), followed by the induction phase (20.3%). During maintenance, 347 episodes were encountered, with nonspecific viral upper respiratory tract infections (URIs) being the commonest diagnosis (40.0%). Additionally, 38 of 58 total specific viral infections occurred during maintenance: 16 herpes simplex, 7 varicella, 10 herpes zoster infections [varicella–zoster virus (VZV), 45%]. The majority of bacteremia and fever of unknown origin occurred during induction (20%). The number of Gram-negative bacteremia was 50% of the total (26 of 52). The majority of the infections (59.5%) occurred without neutropenia [absolute neutrophil count (ANC) >1,000 μl−1]. Fewer infections (9.3%) were recorded with concurrent very severe neutropenia (ANC <100 μl−1), although 38.5% of positive blood cultures were documented with severe neutropenia. No infection-related fatality occurred.

Conclusions

Most of the severe infections occurred during induction. Gram-positive bacteremia and Gram-negative bacteremia were almost equal. URIs were the commonest infections during the entire treatment and during maintenance. Specific viral infections represented a smaller percentage of the total (VZV was the commonest pathogen). Infectious complications represented a significant morbidity factor, but notably, mortality was negligible.

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Acknowledgements

We would like to thank our nursing, laboratory, secretarial, and social worker staff for providing excellent care and support to our patients. The parents associations “FLOGA”, “PISTI” as well as the “ELPIDA” Foundation have provided emotional and financial support to our patients. Finally, we need to thank the “LILIAN VOUDOURI” Foundation for their generous donation of scientific instruments for our clinic and laboratory.

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Authors and Affiliations

  1. Department of Pediatric Hematology–Oncology, Aghia Sophia Children’s Hospital, Thivon & Livadias Ave, Goudi, Athens, 11527, Greece

    Katerina Katsimpardi, Vassilios Papadakis, Agapi Parcharidou, John P. Panagiotou, Sophia Polychronopoulou & Stavros Haidas

  2. Department of Microbiology, Aghia Sophia Children’s Hospital, Thivon & Livadias Ave, Goudi, Athens, 11527, Greece

    Anastasia Pangalis

  3. Second Department of Surgery, Aghia Sophia Children’s Hospital, Thivon & Livadias Ave, Goudi, Athens, 11527, Greece

    Michael Soutis & Evangelos Papandreou

Authors
  1. Katerina Katsimpardi
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  2. Vassilios Papadakis
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  3. Anastasia Pangalis
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  4. Agapi Parcharidou
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  5. John P. Panagiotou
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  6. Michael Soutis
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  7. Evangelos Papandreou
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  8. Sophia Polychronopoulou
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  9. Stavros Haidas
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Corresponding author

Correspondence to Vassilios Papadakis.

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Katsimpardi, K., Papadakis, V., Pangalis, A. et al. Infections in a pediatric patient cohort with acute lymphoblastic leukemia during the entire course of treatment. Support Care Cancer 14, 277–284 (2006). https://doi.org/10.1007/s00520-005-0884-6

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  • DOI: https://doi.org/10.1007/s00520-005-0884-6

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