Pharmacological prophylaxis of infection in pediatric acute myeloid leukemia patients

ABSTRACT

Introduction: Pediatric patients treated for acute myeloid leukemia (AML) are at high risk of developing severe infectious complications. The choice of an optimum supportive treatment should be based on local epidemiology, as well as intensity and toxicity of the anti-leukemic therapy applied.

Areas covered: This review presents an overview of recently published studies focusing on the prevention of infection in pediatric AML patients. PubMed has been systematically searched for clinical trials, reviews, and meta-analyses published in the last 10 years. The focus of this article will be limited to primary prophylaxis only, while secondary prophylaxis is beyond the scope of the current review.

Expert opinion: Although anti-bacterial agents may decrease the bacterial infection burden, there is no consensus regarding prophylactic use. To that end, there is a need for further randomized controlled trials to establish the precise role of anti-bacterial prophylaxis in pediatric AML patients. The prophylactic use of anti-fungal agents is strongly recommended for all AML patients. Since the contribution of hematopoietic growth factors to improved survival has not been demonstrated, they should not be routinely applied. Decisions regarding an appropriate prophylactic strategy should be taken in collaboration with the infectious disease experts and pharmacology team.

KEYWORDS:

• Acute myeloid leukemia
• children
• infection
• prophylaxis

Article highlights

• Pediatric patients with AML receive intensive chemotherapy and thus are at increased risk for severe infection, bacterial and fungal.

• It is extremely important to know the epidemiology, hospital and national, in order to understand the need for preventive measures and prophylactic therapy.

• Collaboration and teamwork with Infectious Disease experts, infection control team, clinical pharmacology, and the pediatric hemato-oncologist are a key to the success in addressing prophylaxis among pediatric AML patients.

• Most studies are either retrospective or extrapolated from adult patients, although there is a significant difference in the pharmacokinetics, pharmacodynamics as well as susceptibility for specific infections between pediatric and adults and within the different pediatric age groups.

• One of the common bacteria among AML patients is viridans group streptococcus, which may cause severe infection with high morbidity and mortality.

• Most of the literature regarding prophylaxis for bacterial infection are retrospective studies and there is no consensus nor clear recommendation for prophylaxis. The decision should be based on local epidemiology.

• Patients with AML are at increased risk for fungal infections (yeast and mold). It is recommended to give antifungal prophylaxis for all pediatric AML patients.

• Hematopoietic growth factors have not been shown to influence the risk of infectious complications nor of mortality rate and thus should not be routinely recommended for prophylaxis.

• Viral infections may be severe, particularly during the induction phase. Acyclovir prophylaxis may be considered in patients with recurrent reactivations. Influenza vaccine is recommended for all caregivers.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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Funding

This manuscript has not been funded.