Clinical characteristics and risk factors of acute lymphoblastic leukemia in children with severe infection during maintenance treatment

• Published in: Cancer medicine (Malden, MA) Vol. 12; no. 19; pp. 19372 - 19382
• Main Authors: Yin, Tiantian, Han, Juan, Hao, Jinjin, Yu, Hui, Qiu, Yining, Xu, Jiawei, Peng, Yun, Wu, Xiaoyan, Jin, Runming, Zhou, Fen
• Format: Journal Article
• Language: English
• Published: Bognor Regis John Wiley & Sons, Inc 01-10-2023; John Wiley and Sons Inc; Wiley
• Subjects: Acute lymphoblastic leukemia; Blood; Chemotherapy; children; Consciousness; Cough; Drug dosages; Globulins; Infections; Leukemia; Lymphatic leukemia; maintenance phase; Neutropenia; Patients; Pneumonia; Risk factors; severe infection; Statistical analysis; Tumors; Urogenital system
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.6495

Background
Infection is the most common adverse event of acute lymphoblastic leukemia (ALL) treatment and is also one of the main causes of death.
Methods
To investigate the clinical characteristics and risk factors of severe infections during the maintenance phase of ALL treatment, we conducted a retrospective study.
Results
A total of 181 children were eligible and 46 patients (25.4%) suffered from 51 events of severe infection, most of which occurred in the first half year of the maintenance phase (52.9%). The most common infection was pulmonary infection (86.3%) followed by bloodstream infection (19.6%). The main symptoms of ALL patients with pulmonary infection were fever, cough, and shortness of breath. The main manifestations of computer tomography (CT) were ground glass shadow (56.8%), consolidation shadow (27.3%), and streak shadow (25%). Multivariate binary logistic regression analysis showed that agranulocytosis, agranulocytosis ≥7 days, anemia, and low globulin level were independent risk factors for severe infection during the maintenance phase (all p < 0.05).
Conclusions
Taken together, blood routine examinations and protein levels should be monitored regularly for ALL patients in the maintenance phase, especially in the first 6 months. For ALL patients with risk factors, preventive anti‐infective or supportive therapies can be given as appropriate to reduce the occurrence of severe infections.