Young age, white race, intensive chemotherapy, and lack of neutrophil surge after dexamethasone treatment were associated with infection-related complications in pediatric patients with acute lymphoblastic leukemia (ALL), according to a study published in the journal Annals of Oncology.1

Because data on neutropenia and infection-related complications in patients with ALL are lacking, researchers sought to examine characteristics and risk factors of infection-related complications in children with newly diagnosed ALL.

For the study, investigators analyzed data from 409 pediatric patients with ALL who experienced a total of 2420 infection episodes. Of those, 1107 episodes were febrile neutropenic patients and 1312 were seen in those with microbiologically documented infection.

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Among documented infection episodes, researchers found that the most common site of infection was upper respiratory tract, followed by ear, bloodstream, and gastrointestinal tract. Results showed that these episodes occurred during intensified therapy phases such as remission induction and reinduction most frequently; however, respiratory and ear infections also occurred during continuation phases.

The study further demonstrated that the incidence of infection-related death was low, with only approximately 1% dying from infection in 3 years. There was no fungal infection-related mortality.

In addition, researchers found that age between 1 year and 9.9 years at diagnosis (P =.002), white race (P =.034), receipt of intensive chemotherapy (P =.043), and poor neutrophil surge after dexamethasone pulses during continuation (P <.001) were associated with infections.

Young age and intensive chemotherapy were also associated with higher rates of febrile neutropenia (P <.001).

The findings ultimately suggest that these patients should be closely monitored for infection so that antibiotics can be promptly administered; chemotherapy modification should also be considered in these patients.


1. Inaba H, Pei D, Wolf J, et al. Infection-related complications during treatment for childhood acute lymphoblastic leukemia. Ann Oncol. 2016 Oct 25. doi: 10.1093/annonc/mdw557. [Epub ahead of print]