Patients with AML are at significantly increased risk of infections during therapy.
In CCG 2961:
- Over 60% of patients had infections in each phase of chemotherapy
Important contributors to infection related mortality:
- Age
- Ethnicity
- Weight loss
Empiric therapy with antibiotics with Gram negative coverage and Pseudomonas in particular
Initial regimen should include agents with activity against viridans group Streptococcus as these organisms are common cause fulminant sepsis in children with AML
High risk invasive fungal infection so prophylaxis with Fluconazole and low threshold for empiric antifungal therapy
Hematopoietic growth factors:
- Include Granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF).
- During AML induction therapy these agents reduce the toxicity associated with prolonged myelosuppression.
- Reduce duration of neutropenia by several days
- However, they do not appear to affect treatment related mortality
- Routine prophylactic use of hematopoietic growth factors is not recommended for children with AML.
