Analyse of Febrile Neutropenia Attacks in Children with Acute Lymphoblastic Leukemia

Febrile neutropenia (FN) is the most important cause of morbidity and mortality during treatment in childhood with acute lymphoblastic leukemia (ALL). The aim of this retrospective study was to assess clinical features, outcomes, treatment modalities, documented infection rates, and frequency of isolation of specific organisms from ALL patients treated by our Department of Pediatric Hematology and Oncology using Berlin-Frankfurt-Munich (BFM) protocols. In this study 132 children diagnosed with ALL and treated according to the ALL-BFM 2009 protocol at Kayseri City Hospital, Department of Pediatric Hematology and Oncology between July 2015 and May 2022 were enrolled and evaluated for episodes of FN during intensive chemotherapy. Treatment characteristics, the presence of relapse, duration of neutropenia, culture results, the choice and duration of antibiotics, and disease prognosis were retrospectively assessed using patient records. In 132 acute leukemia cases, 278 episodes of FN were observed aged 1.1 and 17.8 years (mean 7.1±4.9 years) in a male to female ratio of 1.5:1. Infection focus could be documented in 66 episodes (23.7%); pulmonary infections in 23 patients (34.8%), gastrointestinal tract infections in 20 patients (30.3%), in 10 patients urinary tract infections (15.1%), derma¬otological and soft tissue infections in 2 patients (3%). The causative infectious agent could be demonstrated in 92 (33%) episodes. The most common site of isolation was blood (86/92, 30.9%). While the most frequently identified bacterial infectious agents were Gram-positive bacteria (56 isolates, 20.1%), Gram-negative bacteria were identified in 28 isolates (n=10%). Fungal growth was detected in 6 (2.1%) patients and polymicrobial growth was detected in 3 (1.1%) patients. Of the 132 patients, 4 (3%) died due to infection 2 died during induction, and 2 died during reinduction phases. Centers should evaluate their results to identify changing epidemiological patterns and to treat FN early and efficiently

High Infection-Related Mortality in Pediatric Acute Myeloid Leukemia without Preventive Antibiotics and Antifungals: Retrospective Cohort Study of a Single Center from a Middle-Income Country

Objective: This study aimed to evaluate infection-related mortality in patients with acute myeloid leukemia (AML) treated without preventive antibiotics and antifungals in a middle-income country. Materials and Methods: Infection-related mortality was evaluated retrospectively in 49 pediatric patients. Results: A total of 173 chemotherapy courses were administered as first-line chemotherapy. Four patients died during induction: one patient due to intracranial bleeding, two patients due to typhlitis, and one patient due to invasive fungal infection with pulmonary vascular invasion and massive bleeding. Another two patients died with resistant disease. During consolidation there were four infection-related deaths and one death due to cardiotoxicity. In first-line chemotherapy mortality was 22% (11/49); infection-related mortality was 14% (7/49). Event-free survival and overall survival at 6 years were 42.9% and 61.2% (95% CI: 44-76 and 66-99 months), respectively. Conclusion: Due to considerable infection-related deaths, antibacterial and mold-active antifungal prophylaxis may be tried during neutropenic periods in pediatric AML