文章：

急性髓系白血病儿童的感染并发症：多中心试验AML-BFM 2004中死亡率降低

Infectious complications in children with acute myeloid leukemia: decreased mortality in multicenter trial AML-BFM 2004

原文发布日期：2016-01-15

DOI: 10.1038/bcj.2015.110

类型: Original Article

开放获取: 是

英文摘要：

Infections are an important cause for morbidity and mortality in pediatric acute myeloid leukemia (AML). We therefore characterized infectious complications in children treated according to the trial AML-BFM 2004. Patients with Down syndrome were excluded from the analysis. Data were gathered from the medical records in the hospital where the patients were treated. A total of 405 patients (203 girls; median age 8.4 years) experienced 1326 infections. Fever without identifiable source occurred in 56.1% of the patients and clinically and microbiologically documented infections in 17.5% and 32.4% of the patients, respectively. In all, 240 Gram-positive (112 viridans group streptococci) and 90 Gram-negative isolates were recovered from the bloodstream. Invasive fungal infection was diagnosed in 3% of the patients. Three children each died of Gram-negative bacteremia and invasive aspergillosis, respectively. As compared with the results of AML-BFM 93 with lower dose intensity, infection-related morbidity was slightly higher in AML-BFM 2004 (3.3. versus 2.8 infections per patient), whereas infection-related mortality significantly decreased (1.5% versus 5.4%; P=0.003). Specific anti-infective recommendations included in the treatment protocol, regular training courses for pediatric hematologists and increasing experience may be the reason for reduced infection-related mortality in children with AML. Further studies are needed to decrease infection-related morbidity.

摘要翻译： 

感染是儿童急性髓系白血病（AML）发病和死亡的重要原因。为此，我们根据AML-BFM 2004试验方案，对接受治疗的儿童感染并发症特征进行了分析。唐氏综合征患者被排除在本研究之外。数据从患者所在医院的医疗记录中收集完成。共405例患者（203名女童；中位年龄8.4岁）经历了1326次感染。其中56.1%的患者出现不明原因发热，临床确诊感染和微生物学确诊感染分别占17.5%和32.4%。血液标本共分离出240株革兰阳性菌（其中112株为草绿色链球菌群）和90株革兰阴性菌。3%的患者被诊断为侵袭性真菌感染。分别有3例儿童死于革兰阴性菌血症和侵袭性曲霉病。与剂量强度较低的AML-BFM 93研究结果相比，AML-BFM 2004的感染相关发病率略有上升（每名患者3.3次感染 vs 2.8次），但感染相关死亡率显著降低（1.5% vs 5.4%；P=0.003）。治疗方案中包含的特异性抗感染建议、对儿科血液医师的定期培训以及日益积累的临床经验，可能是降低儿童AML感染相关死亡率的原因。仍需进一步研究以降低感染相关发病率。

原文链接：

Infectious complications in children with acute myeloid leukemia: decreased mortality in multicenter trial AML-BFM 2004