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

TitleEffectiveness of supportive care measures to reduce infections in pediatric AML: a report from the Children's Oncology Group.
Publication TypeJournal Article
Year of Publication2013
AuthorsSung L, Aplenc R, Alonzo TA, Gerbing RB, Lehrnbecher T, Gamis AS
JournalBlood
Volume121
Issue18
Pagination3573-7
Date Published2013 May 2
ISSN1528-0020
KeywordsAdolescent, Anti-Bacterial Agents, Antibiotic Prophylaxis, Antifungal Agents, Antineoplastic Combined Chemotherapy Protocols, Bacterial Infections, Child, Child, Preschool, Female, Granulocyte Colony-Stimulating Factor, Humans, Infant, Infant, Newborn, Leukemia, Myeloid, Acute, Male, Palliative Care, Treatment Outcome
Abstract

Objective was to describe the effect of antibiotic and granulocyte colony-stimulating factor (G-CSF) prophylaxis and discharge policy on infection risk and nonrelapse-related 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 survey-responding institutions. In multiple regression, antibacterial prophylaxis reduced any sterile-site bacterial infection (incidence rate ratio [IRR] 0.85; 95% confidence interval [CI], 0.72-1.01; P = .058) and Gram-positive sterile-site infection (IRR 0.71; 95% CI, 0.57-0.90; P = .004). Prophylactic G-CSF reduced bacterial (IRR 0.79; 95% CI, 0.67-0.92; P = .004) and Clostridium difficile infections (CDIs; IRR 0.46; 95% CI, 0.25-0.84; P = .012). 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.

DOI10.1182/blood-2013-01-476614
Alternate JournalBlood
PubMed ID23471307
PubMed Central IDPMC3643758
Grant List87719 / / Canadian Institutes of Health Research / Canada
U10 CA095861 / CA / NCI NIH HHS / United States
U10 CA098413 / CA / NCI NIH HHS / United States
U10 CA098543 / CA / NCI NIH HHS / United States
U10 CA98543-08 / CA / NCI NIH HHS / United States