Supportive care in pediatric acute myeloid leukemia:Expert-based recommendations of the NOPHO-DB-SHIP consortium

ABSTRACT

Introduction

Pediatric acute myeloid leukemia (AML) is the second most common type of pediatric leukemia. Patients with AML are at high risk for several complications such as infections, typhlitis, and acute and long-term cardiotoxicity. Despite this knowledge, there are no definite supportive care guidelines as to what the best approach is to manage or prevent these complications.

Area covered

The NOPHO-DB-SHIP (Nordic-Dutch-Belgian-Spain-Hong-Kong-Israel-Portugal) consortium, in preparation for a new trial in pediatric AML patients, had dedicated meetings for supportive care. In this review, the authors discuss the available data and outline recommendations for the management of children and adolescents with AML with an emphasis on hyperleukocytosis, tumor lysis syndrome, coagulation abnormalities and bleeding, infection, typhlitis, malnutrition, cardiotoxicity, and fertility preservation.

Expert opinion

Improved supportive care has significantly contributed to increased cure rates. Recommendations on supportive care are an essential part of treatment for this highly susceptible population and will further improve their outcome.

KEYWORDS:

• Acute myeloid leukemia
• cardiotoxicity
• children
• coagulation
• hyperleukocytosis
• infection
• supportive care
• tumor lysis syndrome
• typhlitis

Article highlights

• Supportive care plays a significant role in the improvement of survival among pediatric AML patients. However, for various topics of supportive care, there are no uniform guidelines.

• In patients with hyperleukocytosis, immediate initiation of chemotherapy is crucial. In most cases, it is possible to avoid leukapheresis.

• There is no consensus on the benefit of prophylaxis for bacterial infection. As most of the literature is retrospective studies, prospective studies are warranted.

• All patients should receive prophylactic antifungal treatment. The drug of choice depends on the local epidemiology, drug interaction potential, side effect profile, age, compliance, cost, and availability of the drug,

• The use of G-CSF as a prophylactic measure should not be routinely recommended since a reduction in infection risks or mortality rates has not been documented and it may increase the risk of relapse.

• Considering long-term toxicity such as cardiotoxicity, Dexrazoxane should be considered, along with improved methods to detect early, subclinical decline in cardiac function.

List of abbreviations

Table

Acknowledgments

The authors wish to thank Prof. Anne Tierens for her invaluable expertise and contribution to the NOPHO-DBH 2012 protocol.

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.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737140.2022.2131544

Additional information

Funding

The authors have no funding to report.