1. INFECTIOUS COMPLICATIONS DURING INDUCTION CHEMOTHERAPY IN CHILDREN WITH ACUTE MYELOID LEUKEMIA (AML) K G Gopakumar, Priyakumari T, Kusumakumary P Regional Cancer Centre, Thiruvananthapuram
Code: MM -1.2
BACKGROUND: Infections are an important cause of morbidity and mortality in children with acute myeloid leukemia (AML) and is likely related to the intensity of their therapy resulting in repeated episodes of prolonged and profound neutropenia. Scarcity of Indian studies on this aspect prompted us to attempt this study
RESULT: A total of 27 induction cycles of chemotherapy were studied for infectious complications. The mean age at diagnosis was 5yrs (8months – 13years) and male: female ratio was 1:0.7. AML M5 accounted for the majority of diagnosis (65%). There were a total of 44 infectious events (1.6 infection/induction cycle), of which 40% (n =19) were microbiologically proven. Spectrum of infections are as depicted in the figure. Bacterial infections constituted 68 % (n=15) of all proven infections. Among the bacterial infections, gram negative organisms were isolated in most of the infections (75%, n=10). 3 children had fungemia with candida parapsilosis and 3 children had varicella zoster infection and were treated appropriately. There was no Catheter related Blood stream infection (CRBSI). All infections were acquired/ manifested during the neutropenic period following chemotherapy. 3 children succumbed to infectious complications during induction accounting for a mortality rate of 17%.
METHOD: Prospective study was started in March 2016, with the aim of analysing the infection profile of children below 14years undergoing treatment for AML. Interim analysis of the ongoing study is being presented here. Children with newly diagnosed AML by standard bone marrow examination and flow cytometry were included. Induction chemotherapy was with standard AML 7+3 induction protocol after securing a central venous access (PICC line/ Broviac) in all patients. All children received prophylactic fluoroquinolones and antifungals in post induction period.
CONCLUSION: Infectious complications are common during treatment of AML. Prophylactic antibiotic treatment does not seem to help much in preventing infections. Bacterial infections outnumber viral/fungal infections with gram negative bacteria being the culprit in most events. Further studies aimed at assessing prevention and treatment of infections would help us in developing strategies to decrease infection related mortality.