Infections during induction therapy of childhood acute lymphoblastic leukemia with MRC-11 protocol

Background: During the induction phase of childhood acute lymphoblastic leukemia infections are the major cause of morbidity and mortality. The infection risk is high during induction phase because of the use of intravenous line, mucositis and chemotherapy induced profound neutropenia and immunodeficiency. Methods: This hospital based observational study was done from February 2015 to June 2015 in the Department of Pediatric Hematology-oncology in BSMMU to observe the type, frequency and outcome of infections and to determine the microbiological profile involved in infections during induction therapy of childhood acute lymphoblastic leukemia. Total 20 diagnosed cases of childhood ALL who were admitted for chemotherapy aged <12 yrs. of both sexes included in this study. Children with fever ≥ 38○ C lasting for 1 hour once with or without local symptoms of infection like cough, dysuria, diarrhea, cellulitis etc. during induction therapy were included. All baseline investigations were done for evaluation. Results: Mean age of the patients was 5.4±4 years having male predominance. 36 episodes of infections among 20 patients were observed. Isolated febrile episodes 27.8% and clinically documented infections 72.2%. The most common site was the Respiratory system (33.2%) of episodes then thrombophlebitis (13.9%), GIT (13.9%), Genitourinary system (5.6%), soft tissue infection (2.8%), ear infection (2.8%). ANC <500/mm3 was the major risk of infections. Microbiologically documented infections found 7 episodes (19.4%) out of 36 episodes. Gram negative bacilli such as Pseudomonas (42.9%), E. coli (28.4%) was predominant organism. Conclusion: Children less than 5 years were mostly vulnerable. Most of the infections occurred during induction associated with neutropenia (ANC <500/mm3). Gram negative bacteria were predominant organisms involved in infections. The Respiratory system was the commonest site of infection. Outcome of infectious episodes were satisfactory with or without modification of antibiotic regimen.