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Infectious Events Prior to Chemotherapy Initiation in Children with Acute Myeloid Leukemia
Published: Friday, April 26, 2013
Author: Carol Portwine et al.

by Carol Portwine, David Mitchell, Donna Johnston, Biljana Gillmeister, Marie-Chantal Ethier, Rochelle Yanofsky, David Dix, Sonia Cellot, Victor Lewis, Victoria Price, Mariana Silva, Shayna Zelcer, Lynette Bowes, Bruno Michon, Kent Stobart, Josee Brossard, Joseph Beyene, Lillian Sung

Background

The primary objective was to describe infectious complications in children with acute myeloid leukemia from presentation to the healthcare system to initiation of chemotherapy and to describe how these infections differ depending on neutropenia.

Methods

We conducted a retrospective, population-based cohort study that included children and adolescents with acute myeloid leukemia diagnosed and treated at 15 Canadian centers. We evaluated infections that occurred between presentation to the healthcare system (for symptoms that led to the diagnosis of acute myeloid leukemia) until initiation of chemotherapy.

Results

Among 328 children, 92 (28.0%) were neutropenic at presentation. Eleven (3.4%) had sterile-site microbiologically documented infection and four had bacteremia (only one Gram negative). Infection rate was not influenced by neutropenia. No child died from an infectious cause prior to chemotherapy initiation.

Conclusion

It may be reasonable to withhold empiric antibiotics in febrile non-neutropenic children with newly diagnosed acute myeloid leukemia until initiation of chemotherapy as long as they appear well without a clinical focus of infection. Future work could examine biomarkers or a clinical score to identify children presenting with leukemia and fever who are more likely to have an invasive infection.

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