Chemotherapy for Childhood Acute Myeloid Leukemia and Associated Infections Over Two Decades in India: Timeline and Impact on Outcome

Ramya Uppuluri; Venkateswaran Venkateswaran Swaminathan; Nikila Ravichandran; Kesavan Melarcode Ramanan; Satishkumar Meena; Harika Varla; Balasubramaniam Ramakrishnan; Indira Jayakumar; Revathi Raj

doi:10.4103/ijmpo.ijmpo_211_20

Indian Journal of Medical and Paediatric Oncology, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2020; 41(06): 869-873
DOI: 10.4103/ijmpo.ijmpo_211_20

Original Article

Chemotherapy for Childhood Acute Myeloid Leukemia and Associated Infections Over Two Decades in India: Timeline and Impact on Outcome

Ramya Uppuluri

Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, Tamil Nadu, India

,

Venkateswaran Venkateswaran Swaminathan

Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, Tamil Nadu, India

,

Nikila Ravichandran

Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, Tamil Nadu, India

,

Kesavan Melarcode Ramanan

Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, Tamil Nadu, India

,

Satishkumar Meena

Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, Tamil Nadu, India

,

Harika Varla

Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, Tamil Nadu, India

,

Balasubramaniam Ramakrishnan

Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, Tamil Nadu, India

,

Indira Jayakumar

Department of Pediatric Critical Care, Apollo Hospitals, Chennai, Tamil Nadu, India

,

Revathi Raj

Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Apollo Hospitals, Chennai, Tamil Nadu, India

› Institutsangaben

Abstract

Background: Infection and relapse constitute the two main challenges in the management of acute myeloid leukemia (AML) in children. Real-world data in children treated in low-and-middle income countries are sparse as the cost of supportive care is high. Patients and Methods: We present data on children up to 18 years of age undergoing chemotherapy for AML as per UKMRC AML protocol from 2002 to June 2019 and pattern of sepsis. Results: The incidence of culture-positive sepsis was similar pre- and post-2012 (52.6% vs. 72.4%), Klebsiella pneumoniae being the most common organism. There was a significant increase in carbapenem resistance post 2012 (14% vs. 67%, P = 0.032). Sepsis-related induction mortality has remained at 6.2% despite an increase in drug-resistant bacterial infections over two decades. The overall survival was 53% (n=48), with a plateau in the survival curve after 24 months, relapse being the most common cause of death (69%). Conclusions: Sepsis-related induction mortality can be maintained at less than 10% in children undergoing chemotherapy for AML, despite increasing drug-resistant bacteremia, with adequate supportive care and trained personnel including pediatric intensivists and nurses.

Keywords

Childhood acute myeloid leukemia - drug-resistant sepsis - hematopoietic stem cell transplantation - relapse - sepsis-related mortality

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Referenzen

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