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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

Authors

  • 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

Financial support and sponsorship Nil.
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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


Publication History

Received: 02 May 2020

Accepted: 02 October 2020

Article published online:
14 May 2021

© 2020. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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