Infections In Childhood Acute Lymphoblastic Leukemia During Induction Therapy:an Analysis Of339Childhood Treated With CCLG-08Protocols

Objective To estimate the complications induced by CCLG-08protocol (children cancer and leukemia group-2008) during induction theropy in children with acute lymphoblastic leukemia, especially,the infection rate among the three groups;To report the primary site of infection and bacterial isolates; The time of infection and the high risk factors for the infection;The rate of the fungal infection during induction phase. Methods The study analysis was performed on339children with diagnosis of ALL in our hospital from2008to2011, who were treated with the CCLG-08protocol. So the same table to the children, whose induction therapy with prednisone instead of dexamethasone(CAMS-ALL-2002protocol) were registed. Outcomes1.In CCLG-2008protocol, there were303patients to complete the study in339ALL, and195patients (195/303,64.36%) had infections, the rate of the each group was64.90%,64.19%,63.38%respectively, no statistical significance. Of the195patients,110(56.41%) had documented focus of infection,respiratory tract infection were the commonest site of infection (91/110,82.72%), followed by blood infection (33/110,30%),oral cavity(13/110,11.82%), gastrointestinal infection (7/110,6.36%),skin and tissues (3/110,2.72%),73patients (73/195,37.43%) were given anti-fungal treatment.Of42(42/110,38.18%) bacterial isolates,G-bacteria (29/41,70.73%) were about twice as common as G+bacteria(12/41,29.27%);one was fungal sepsis Klebsiella(9/29,31.03%)were the commonest isolate,followed by Escherichia coli (8/29,27.59%), Pseudo-monas(6/29,20.69%).150patients’ infection(150/195,76.92%) were contro-led with first line anti-infection, and45patients(45/195,23.08%) were added to another antibitics.2、In CAMS-ALL-2002protocol,there were79patients to complete the induction therapy, the whole infective rate was55.70%(44/79,55.7%), the mortality was2.53%(2/79)。18patients (18/44,40.91%) had documented focus of infection, respiratory tract infection were the commonest site of infection (16/18,88.89%), followed by blood infection (4/18,30%), oral cavity(4/18,11.82%),crissum infection(1/18,5.56%),Intra-calvarium infection (1/18,5.56%), and73patients (6/44,13.64%) were given anti-fungal treatment. There were only4patients had definitive Micro-organism, klebsiella. pneumoniae,streptococcus. pneumoniae, Bran-hamella catarrhalis, Staphylococcus hominis.38patients’infection (38/44,86.36%) were controled with first line anti-infection therapy, and6patients (6/44,13.64%)were added to another antibitics. Conclusion In CCLG-2008protocol, there were no difference in the three groups of the rate of infection. The respiratory tract was the commonest infective site; and most of the isolate was G-Microorganisms; infection almost happened at the time of the medial induction therapy.Younger age, prolonged and severe neutropenia were the high risk factors. Dexamethasone do not increase the infective risk.