Invasive Fungal Infection Incidence in Pediatric Acute Myeloid Leukemia Decreases, Despite Increase in Bloodstream Infections

Strategic Insights -

A recent study published in Pediatric Blood & Cancer has investigated the incidence and risk factors of bloodstream infection (BSI) and invasive fungal infection (IFI) in pediatric acute myeloid leukemia (pAML) patients treated according to various protocols between 1998 and 2014. The study found that the cumulative incidence of any BSI was 78%, while the incidence of IFI was 11% through Day 150. Notably, the incidence of Gram-negative rod (GNR) BSI decreased over time, with hazard ratios of 0.37 and 0.42 for AML-15 and DB AML-01 protocols compared to ANLL-97/AML-12.

Key Takeaways:

  • The cumulative incidence of any BSI was 78% through Day 150 in pediatric acute myeloid leukemia patients.
  • The incidence of IFI was 11% through Day 150.
  • The incidence of Gram-negative rod (GNR) BSI decreased over time, with hazard ratios of 0.37 and 0.42 for AML-15 and DB AML-01 protocols compared to ANLL-97/AML-12.
  • White blood cell counts 20 x 10^9/L at diagnosis and older age were associated with lower infection risk.
  • Recurrent event analyses showed a higher risk of subsequent BSI for patients who had two or more prior BSIs.
  • The study suggests that future research should focus on decreasing the incidence of infection while maintaining treatment efficacy.
  • The study examined data from patients treated according to ANLL-97/AML-12 (N = 116), AML-15 (N = 60), or DB AML-01 (N = 67) protocols.

Statistics:

  • The cumulative incidence of any BSI was 78% through Day 150.
  • The incidence of IFI was 11% through Day 150.
  • The incidence of GNR BSI decreased by 63% (from 15% to 5.6%) through Day 150.
  • The risk of subsequent BSI increased by 85% for patients with two or more prior BSIs.

Sources:

  • Infectious Morbidity During Pediatric Acute Myeloid Leukemia Chemotherapy in a High-Income Country: A 15-Year Population-Based Overview (Pediatric Blood & Cancer, 2025).
  • Amsterdam University Medical Center.
  • Emma Children's Hospital, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands.