Effectiveness of supportive care measures to reduce infections in pediatric AML: a report from the Children’s Oncology Group

Abstract

• Systemic antibacterial and granulocyte colony-stimulating factor prophylaxis appear to reduce bacterial infection rates.• Mandatory hospitalization during profound neutropenia did not reduce infection or significantly reduce nonrelapse-related mortality.Objective was to describe the effect of antibiotic and granulocyte colony-stimulating factor (G-CSF) prophylaxis and discharge policy on infection risk and nonrelapserelated mortality (NRM) during chemotherapy for children with acute myeloid leukemia.Patients were non-Down syndrome children enrolled on Children's Oncology Group (COG) trial AAML0531. We surveyed sites to determine institutional standards for systemic antibacterial, antifungal, and G-CSF prophylaxis, and mandatory hospitalization during neutropenia. COG institution survey response rate was 180 of 216 (83.3%).Of 1024 patients enrolled on AAML0531, 897 were non-Down patients from surveyresponding institutions. In multiple regression, antibacterial prophylaxis reduced any sterile-site bacterial infection (incidence rate ratio Mandatory hospitalization did not reduce bacterial/fungal infection or significantly reduce NRM but did increase CDI (IRR 1.96; 95% CI, 1.34-2.87; P < .001). Antibacterial and G-CSF prophylaxis reduced infection rates while mandatory hospitalization did not reduce infection or significantly affect NRM. This trial was registered at www. clinicaltrials.gov as #AAML0531. (Blood. 2013;121(18):3573-3577)

Feasibility, efficacy, and adverse effects of outpatient antibacterial prophylaxis in children with acute myeloid leukemia

“…7 In the Children’s Oncology Group AAML0531 study, antibacterial prophylaxis significantly reduced the frequency of sterile-site bacterial infections, including gram-positive infections. 11 However, emergence of drug resistance remains a concern. 12, 13 …”

Clinical and Microbiologic Outcomes of Quinolone Prophylaxis in Children With Acute Myeloid Leukemia

“…2,3 In adult oncology and hematopoietic progenitor cell transplant (HPCT) populations, quinolone prophylaxis decreases infection-related and all-cause mortality and morbidity. [4][5][6] Prophylactic antibiotics increase survival and lower morbidity in children with hematologic malignancies, [7][8][9] but no unifying recommendations for their use in specific subsets of patients have been agreed upon. 2,10 The Infectious Diseases Society of America recommends quinolone prophylaxis in high-risk children including HPCT recipients and those undergoing induction chemotherapy for acute leukemia.…”

Interleukin-6 levels predict event-free survival in pediatric AML and suggest a mechanism of chemotherapy resistance

“…1,2 In the last 50 years, incremental improvements in cure rates for pediatric AML have been achieved by refinements of treatment regimens, improved supportive care, and optimization of risk-stratification algorithms. [2][3][4][5][6] Current algorithms are based on a few cytogenetic changes and mutations and on an individual's response to the initial treatment. 2,7 For pediatric patients with AML, the ability of the algorithm to stratify risk at diagnosis is limited.…”