Infections in pediatric acute promyelocytic leukemia: from the canadian infections in acute myeloid leukemia research group

Background: It is not known whether children with acute promyelocytic leukemia (APL) have an infection risk similar to non-APL acute myeloid leukemia. The objective was to describe infectious risk in children with newly diagnosed APL and to describe factors associated with these infections. Methods: We conducted a retrospective, population-based cohort study that included children <= 18 years of age with de novo APL treated at 15 Canadian centers. Thirty-three children with APL were included; 78.8% were treated with APL specific protocols. Results: Bacterial sterile site infection occurred in 12 (36.4%) and fungal sterile site infection occurred in 2 (6.1%) children. Of the 127 chemotherapy courses, 101 (79.5%) were classified as intensive and among these, the proportion in which a sterile site microbiologically documented infection occurred was 14/101 (13.9%). There was one infection-related death. Conclusions: One third of children with APL experienced at least one sterile site bacterial infection throughout treatment and 14% of intensive chemotherapy courses were associated with a microbiologically documented sterile site infection. Infection rates in pediatric APL may be lower compared to non-APL acute myeloid leukemia although these children may still benefit from aggressive supportive care during intensive chemotherapy.