Infections in pediatric acute promyelocytic leukemia: from the canadian infections in acute myeloid leukemia research group

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

BACKGROUND: It is not known whether children with acute promyelocytic leukemia (APL) have an infection risk similar to non- APL acute myeloid leukemia. The objective was to describe infectious risk in children with newly diagnosed APL and to describe factors associated with these infections. METHODS: We conducted a retrospective, population-based cohort study that included children <= 18 years of age with de novo APL treated at 15 Canadian centers. Thirty-three children with APL were included; 78.8% were treated with APL -specific protocols. RESULTS: Bacterial sterile site infection occurred in 12 (36.4%) and fungal sterile site infection occurred in 2 (6.1%) children. Of the 127 chemotherapy courses, 101 (79.5%) were classified as intensive and among these, the proportion in which a sterile site microbiologically documented infection occurred was 14/101 (13.9%). There was one infection-related death. CONCLUSIONS: One third of children with APL experienced at least one sterile site bacterial infection throughout treatment and 14% of intensive chemotherapy courses were associated with a microbiologically documented sterile site infection. Infection rates in pediatric APL may be lower compared to non- APL acute myeloid leukemia although these children may still benefit from aggressive supportive care during intensive chemotherapy.