Septicemia after chemotherapy for childhood acute lymphoblastic leukemia in China: A multicenter study CCCG‐ALL‐2015
Background Septicemia is an important cause of treatment‐related mortality and treatment failure in pediatric acute lymphoblastic leukemia (ALL) in developing countries. A multicenter CCCG‐ALL‐2015 study was conducted in China and factors associated with septicemia and mortality were studied. Method...
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| Published in | Cancer medicine (Malden, MA) Vol. 9; no. 6; pp. 2113 - 2121 |
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| Main Authors | , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
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United States
John Wiley & Sons, Inc
01.03.2020
John Wiley and Sons Inc Wiley |
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| Abstract | Background
Septicemia is an important cause of treatment‐related mortality and treatment failure in pediatric acute lymphoblastic leukemia (ALL) in developing countries. A multicenter CCCG‐ALL‐2015 study was conducted in China and factors associated with septicemia and mortality were studied.
Methods
Patients participated in CCCG‐ALL‐2015 study from January 2015 to December 2017 were included. Patients with documented septicemia were identified from the Data Center and additional data were collected.
Results
A total of 4080 patients were recruited in the study and 527 patients with septicemia were identified (12.9%, 95% CI 11.9%‐13.9%). The intermediate risk (IR)/high risk (HR) group had significantly higher incidence of septicemia as compared with low risk (LR) group, 17.1% vs 9.1% (OR 2.07, 95% CI 1.71‐2.49, P < .001). Induction phase was the period with majority of septicemia episodes happened, 66.8% in LR and 56.1% in IR/HR groups. Gram‐positive bacteria accounted for 54.1%, gram‐negative bacteria 44.5%, and fungus 1.4% of positive cultures. Multidrug‐resistant organisms were detected in 20.5% of all organisms. The mortality rate after septicemia was 3.4% (95% CI 1.9%‐4.9%). Multiple logistic regression identified female gender, comorbid complications, and fungal infection as risk factors associated with mortality. Gram‐negative septicemia was associated with higher mortality, 4.9% vs 1.4% (OR 0.28, 95% CI 0.09‐0.88, P = .02). There was marked variation in the incidence of septicemia among the 18 centers, from 4.8% to 29.1%.
Conclusion
Overall the incidence and pattern of septicemia in this multicenter study in China was similar to the reports of western countries. The septicemia‐related mortality rate was low. There was marked variation in the incidence of septicemia among the centers.
The incidence and pattern of septicemia in this multicenter study in China was similar to reports of western countries. The septicemia related mortality rate was low. There was marked variation in the incidence of septicemia among the centers. |
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| AbstractList | Abstract Background Septicemia is an important cause of treatment‐related mortality and treatment failure in pediatric acute lymphoblastic leukemia (ALL) in developing countries. A multicenter CCCG‐ALL‐2015 study was conducted in China and factors associated with septicemia and mortality were studied. Methods Patients participated in CCCG‐ALL‐2015 study from January 2015 to December 2017 were included. Patients with documented septicemia were identified from the Data Center and additional data were collected. Results A total of 4080 patients were recruited in the study and 527 patients with septicemia were identified (12.9%, 95% CI 11.9%‐13.9%). The intermediate risk (IR)/high risk (HR) group had significantly higher incidence of septicemia as compared with low risk (LR) group, 17.1% vs 9.1% (OR 2.07, 95% CI 1.71‐2.49, P < .001). Induction phase was the period with majority of septicemia episodes happened, 66.8% in LR and 56.1% in IR/HR groups. Gram‐positive bacteria accounted for 54.1%, gram‐negative bacteria 44.5%, and fungus 1.4% of positive cultures. Multidrug‐resistant organisms were detected in 20.5% of all organisms. The mortality rate after septicemia was 3.4% (95% CI 1.9%‐4.9%). Multiple logistic regression identified female gender, comorbid complications, and fungal infection as risk factors associated with mortality. Gram‐negative septicemia was associated with higher mortality, 4.9% vs 1.4% (OR 0.28, 95% CI 0.09‐0.88, P = .02). There was marked variation in the incidence of septicemia among the 18 centers, from 4.8% to 29.1%. Conclusion Overall the incidence and pattern of septicemia in this multicenter study in China was similar to the reports of western countries. The septicemia‐related mortality rate was low. There was marked variation in the incidence of septicemia among the centers. The incidence and pattern of septicemia in this multicenter study in China was similar to reports of western countries. The septicemia related mortality rate was low. There was marked variation in the incidence of septicemia among the centers. Septicemia is an important cause of treatment-related mortality and treatment failure in pediatric acute lymphoblastic leukemia (ALL) in developing countries. A multicenter CCCG-ALL-2015 study was conducted in China and factors associated with septicemia and mortality were studied. Patients participated in CCCG-ALL-2015 study from January 2015 to December 2017 were included. Patients with documented septicemia were identified from the Data Center and additional data were collected. A total of 4080 patients were recruited in the study and 527 patients with septicemia were identified (12.9%, 95% CI 11.9%-13.9%). The intermediate risk (IR)/high risk (HR) group had significantly higher incidence of septicemia as compared with low risk (LR) group, 17.1% vs 9.1% (OR 2.07, 95% CI 1.71-2.49, P < .001). Induction phase was the period with majority of septicemia episodes happened, 66.8% in LR and 56.1% in IR/HR groups. Gram-positive bacteria accounted for 54.1%, gram-negative bacteria 44.5%, and fungus 1.4% of positive cultures. Multidrug-resistant organisms were detected in 20.5% of all organisms. The mortality rate after septicemia was 3.4% (95% CI 1.9%-4.9%). Multiple logistic regression identified female gender, comorbid complications, and fungal infection as risk factors associated with mortality. Gram-negative septicemia was associated with higher mortality, 4.9% vs 1.4% (OR 0.28, 95% CI 0.09-0.88, P = .02). There was marked variation in the incidence of septicemia among the 18 centers, from 4.8% to 29.1%. Overall the incidence and pattern of septicemia in this multicenter study in China was similar to the reports of western countries. The septicemia-related mortality rate was low. There was marked variation in the incidence of septicemia among the centers. BackgroundSepticemia is an important cause of treatment‐related mortality and treatment failure in pediatric acute lymphoblastic leukemia (ALL) in developing countries. A multicenter CCCG‐ALL‐2015 study was conducted in China and factors associated with septicemia and mortality were studied.MethodsPatients participated in CCCG‐ALL‐2015 study from January 2015 to December 2017 were included. Patients with documented septicemia were identified from the Data Center and additional data were collected.ResultsA total of 4080 patients were recruited in the study and 527 patients with septicemia were identified (12.9%, 95% CI 11.9%‐13.9%). The intermediate risk (IR)/high risk (HR) group had significantly higher incidence of septicemia as compared with low risk (LR) group, 17.1% vs 9.1% (OR 2.07, 95% CI 1.71‐2.49, P < .001). Induction phase was the period with majority of septicemia episodes happened, 66.8% in LR and 56.1% in IR/HR groups. Gram‐positive bacteria accounted for 54.1%, gram‐negative bacteria 44.5%, and fungus 1.4% of positive cultures. Multidrug‐resistant organisms were detected in 20.5% of all organisms. The mortality rate after septicemia was 3.4% (95% CI 1.9%‐4.9%). Multiple logistic regression identified female gender, comorbid complications, and fungal infection as risk factors associated with mortality. Gram‐negative septicemia was associated with higher mortality, 4.9% vs 1.4% (OR 0.28, 95% CI 0.09‐0.88, P = .02). There was marked variation in the incidence of septicemia among the 18 centers, from 4.8% to 29.1%.ConclusionOverall the incidence and pattern of septicemia in this multicenter study in China was similar to the reports of western countries. The septicemia‐related mortality rate was low. There was marked variation in the incidence of septicemia among the centers. Background Septicemia is an important cause of treatment‐related mortality and treatment failure in pediatric acute lymphoblastic leukemia (ALL) in developing countries. A multicenter CCCG‐ALL‐2015 study was conducted in China and factors associated with septicemia and mortality were studied. Methods Patients participated in CCCG‐ALL‐2015 study from January 2015 to December 2017 were included. Patients with documented septicemia were identified from the Data Center and additional data were collected. Results A total of 4080 patients were recruited in the study and 527 patients with septicemia were identified (12.9%, 95% CI 11.9%‐13.9%). The intermediate risk (IR)/high risk (HR) group had significantly higher incidence of septicemia as compared with low risk (LR) group, 17.1% vs 9.1% (OR 2.07, 95% CI 1.71‐2.49, P < .001). Induction phase was the period with majority of septicemia episodes happened, 66.8% in LR and 56.1% in IR/HR groups. Gram‐positive bacteria accounted for 54.1%, gram‐negative bacteria 44.5%, and fungus 1.4% of positive cultures. Multidrug‐resistant organisms were detected in 20.5% of all organisms. The mortality rate after septicemia was 3.4% (95% CI 1.9%‐4.9%). Multiple logistic regression identified female gender, comorbid complications, and fungal infection as risk factors associated with mortality. Gram‐negative septicemia was associated with higher mortality, 4.9% vs 1.4% (OR 0.28, 95% CI 0.09‐0.88, P = .02). There was marked variation in the incidence of septicemia among the 18 centers, from 4.8% to 29.1%. Conclusion Overall the incidence and pattern of septicemia in this multicenter study in China was similar to the reports of western countries. The septicemia‐related mortality rate was low. There was marked variation in the incidence of septicemia among the centers. The incidence and pattern of septicemia in this multicenter study in China was similar to reports of western countries. The septicemia related mortality rate was low. There was marked variation in the incidence of septicemia among the centers. Septicemia is an important cause of treatment-related mortality and treatment failure in pediatric acute lymphoblastic leukemia (ALL) in developing countries. A multicenter CCCG-ALL-2015 study was conducted in China and factors associated with septicemia and mortality were studied.BACKGROUNDSepticemia is an important cause of treatment-related mortality and treatment failure in pediatric acute lymphoblastic leukemia (ALL) in developing countries. A multicenter CCCG-ALL-2015 study was conducted in China and factors associated with septicemia and mortality were studied.Patients participated in CCCG-ALL-2015 study from January 2015 to December 2017 were included. Patients with documented septicemia were identified from the Data Center and additional data were collected.METHODSPatients participated in CCCG-ALL-2015 study from January 2015 to December 2017 were included. Patients with documented septicemia were identified from the Data Center and additional data were collected.A total of 4080 patients were recruited in the study and 527 patients with septicemia were identified (12.9%, 95% CI 11.9%-13.9%). The intermediate risk (IR)/high risk (HR) group had significantly higher incidence of septicemia as compared with low risk (LR) group, 17.1% vs 9.1% (OR 2.07, 95% CI 1.71-2.49, P < .001). Induction phase was the period with majority of septicemia episodes happened, 66.8% in LR and 56.1% in IR/HR groups. Gram-positive bacteria accounted for 54.1%, gram-negative bacteria 44.5%, and fungus 1.4% of positive cultures. Multidrug-resistant organisms were detected in 20.5% of all organisms. The mortality rate after septicemia was 3.4% (95% CI 1.9%-4.9%). Multiple logistic regression identified female gender, comorbid complications, and fungal infection as risk factors associated with mortality. Gram-negative septicemia was associated with higher mortality, 4.9% vs 1.4% (OR 0.28, 95% CI 0.09-0.88, P = .02). There was marked variation in the incidence of septicemia among the 18 centers, from 4.8% to 29.1%.RESULTSA total of 4080 patients were recruited in the study and 527 patients with septicemia were identified (12.9%, 95% CI 11.9%-13.9%). The intermediate risk (IR)/high risk (HR) group had significantly higher incidence of septicemia as compared with low risk (LR) group, 17.1% vs 9.1% (OR 2.07, 95% CI 1.71-2.49, P < .001). Induction phase was the period with majority of septicemia episodes happened, 66.8% in LR and 56.1% in IR/HR groups. Gram-positive bacteria accounted for 54.1%, gram-negative bacteria 44.5%, and fungus 1.4% of positive cultures. Multidrug-resistant organisms were detected in 20.5% of all organisms. The mortality rate after septicemia was 3.4% (95% CI 1.9%-4.9%). Multiple logistic regression identified female gender, comorbid complications, and fungal infection as risk factors associated with mortality. Gram-negative septicemia was associated with higher mortality, 4.9% vs 1.4% (OR 0.28, 95% CI 0.09-0.88, P = .02). There was marked variation in the incidence of septicemia among the 18 centers, from 4.8% to 29.1%.Overall the incidence and pattern of septicemia in this multicenter study in China was similar to the reports of western countries. The septicemia-related mortality rate was low. There was marked variation in the incidence of septicemia among the centers.CONCLUSIONOverall the incidence and pattern of septicemia in this multicenter study in China was similar to the reports of western countries. The septicemia-related mortality rate was low. There was marked variation in the incidence of septicemia among the centers. |
| Author | Wu, Xuedong Pan, Kaili Li, Chi‐kong Zhu, Yiping Jiang, Hui Wang, Ningling Ju, Xiuli Hu, Qun Cheng, Frankie W. T. He, Hailong Chen, Yumei Zhai, Xiaowen Yang, Rong Sun, Lirong He, Yingyi Cai, Jiaoyang Jin, Runming Tian, Xin Yu, Jie Tang, Yanjing Fang, Yongjun |
| AuthorAffiliation | 6 Department of Hematology/Oncology Children's Hospital of Soochow University Suzhou China 7 Department of Pediatrics Nanfang Hospital Southern Medical University Guangzhou China 17 Department of Hematology Oncology Children's hospital of Fudan University Shanghai China 2 Department of Hematology/Oncology Shanghai Children's Medical Center Shanghai Jiaotong University of School of Medicine Shanghai China 12 Department of Hematology/Oncology Kunming Children's Hospital Kunming China 8 Department of Paediatrics Hong Kong Children's Hospital The Chinese University of Hong Kong Hong Kong SAR China 13 Department of Pediatric Hematology Tongji Hospital of Tongji Medical College Huazhong University of Science and Technology Wuhan China 10 Department of Hematology/Oncology Guangzhou Women and Children Health Care Center Guangzhou China 11 Department of Pediatrics Qilu Hospital of Shandong University Jinan China 5 Department of Pediatrics Anhui Medical University Second Affiliated Hospital Hefei China 16 |
| AuthorAffiliation_xml | – name: 17 Department of Hematology Oncology Children's hospital of Fudan University Shanghai China – name: 2 Department of Hematology/Oncology Shanghai Children's Medical Center Shanghai Jiaotong University of School of Medicine Shanghai China – name: 3 Department of Hematology/Oncology Children's Hospital of Chongqing Medical University Chongqing China – name: 10 Department of Hematology/Oncology Guangzhou Women and Children Health Care Center Guangzhou China – name: 13 Department of Pediatric Hematology Tongji Hospital of Tongji Medical College Huazhong University of Science and Technology Wuhan China – name: 1 Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education Department of Pediatric Hematology/Oncology West China Second Hospital of Sichuan University Chengdu China – name: 6 Department of Hematology/Oncology Children's Hospital of Soochow University Suzhou China – name: 15 Department of Hematology/Oncology Xi'an Northwest Women and Children Hospital Xian China – name: 7 Department of Pediatrics Nanfang Hospital Southern Medical University Guangzhou China – name: 18 Department of Hematology Oncology Children's Hospital Affiliated to Shanghai Jiaotong University Shanghai China – name: 14 Department of Pediatrics Union Hospital of Tongji Medical College Huazhong University of Science and Technology Wuhan China – name: 8 Department of Paediatrics Hong Kong Children's Hospital The Chinese University of Hong Kong Hong Kong SAR China – name: 9 Department of Pediatrics Affiliated Hospital of Qingdao University Qingdao China – name: 11 Department of Pediatrics Qilu Hospital of Shandong University Jinan China – name: 12 Department of Hematology/Oncology Kunming Children's Hospital Kunming China – name: 4 State Key Laboratory of Experimental Hematology and Division of Pediatric Blood Diseases Center Institute of Hematology and Blood Disease Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Tianjin China – name: 16 Department of Hematology/Oncology Nanjing Children's Hospital Affiliated to Nanjing Medical University Nanjing China – name: 5 Department of Pediatrics Anhui Medical University Second Affiliated Hospital Hefei China |
| Author_xml | – sequence: 1 givenname: Yiping surname: Zhu fullname: Zhu, Yiping organization: West China Second Hospital of Sichuan University – sequence: 2 givenname: Rong surname: Yang fullname: Yang, Rong organization: West China Second Hospital of Sichuan University – sequence: 3 givenname: Jiaoyang surname: Cai fullname: Cai, Jiaoyang organization: Shanghai Jiaotong University of School of Medicine – sequence: 4 givenname: Jie surname: Yu fullname: Yu, Jie organization: Children's Hospital of Chongqing Medical University – sequence: 5 givenname: Yanjing surname: Tang fullname: Tang, Yanjing organization: Shanghai Jiaotong University of School of Medicine – sequence: 6 givenname: Yumei surname: Chen fullname: Chen, Yumei organization: Chinese Academy of Medical Sciences and Peking Union Medical College – sequence: 7 givenname: Ningling surname: Wang fullname: Wang, Ningling organization: Anhui Medical University Second Affiliated Hospital – sequence: 8 givenname: Hailong surname: He fullname: He, Hailong organization: Children's Hospital of Soochow University – sequence: 9 givenname: Xuedong surname: Wu fullname: Wu, Xuedong organization: Southern Medical University – sequence: 10 givenname: Frankie W. T. surname: Cheng fullname: Cheng, Frankie W. T. organization: The Chinese University of Hong Kong – sequence: 11 givenname: Lirong orcidid: 0000-0003-1724-5146 surname: Sun fullname: Sun, Lirong organization: Affiliated Hospital of Qingdao University – sequence: 12 givenname: Yingyi surname: He fullname: He, Yingyi organization: Guangzhou Women and Children Health Care Center – sequence: 13 givenname: Xiuli surname: Ju fullname: Ju, Xiuli organization: Qilu Hospital of Shandong University – sequence: 14 givenname: Xin surname: Tian fullname: Tian, Xin organization: Kunming Children's Hospital – sequence: 15 givenname: Qun surname: Hu fullname: Hu, Qun organization: Huazhong University of Science and Technology – sequence: 16 givenname: Runming surname: Jin fullname: Jin, Runming organization: Huazhong University of Science and Technology – sequence: 17 givenname: Kaili surname: Pan fullname: Pan, Kaili organization: Xi'an Northwest Women and Children Hospital – sequence: 18 givenname: Yongjun surname: Fang fullname: Fang, Yongjun organization: Nanjing Children's Hospital Affiliated to Nanjing Medical University – sequence: 19 givenname: Xiaowen surname: Zhai fullname: Zhai, Xiaowen organization: Children's hospital of Fudan University – sequence: 20 givenname: Hui surname: Jiang fullname: Jiang, Hui organization: Children's Hospital Affiliated to Shanghai Jiaotong University – sequence: 21 givenname: Chi‐kong orcidid: 0000-0002-2810-5758 surname: Li fullname: Li, Chi‐kong email: ckli@cuhk.edu.hk organization: The Chinese University of Hong Kong |
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| Keywords | mortality multicenter study septicemia acute lymphoblastic leukemia children |
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| Snippet | Background
Septicemia is an important cause of treatment‐related mortality and treatment failure in pediatric acute lymphoblastic leukemia (ALL) in developing... Septicemia is an important cause of treatment-related mortality and treatment failure in pediatric acute lymphoblastic leukemia (ALL) in developing countries.... BackgroundSepticemia is an important cause of treatment‐related mortality and treatment failure in pediatric acute lymphoblastic leukemia (ALL) in developing... The incidence and pattern of septicemia in this multicenter study in China was similar to reports of western countries. The septicemia related mortality rate... Abstract Background Septicemia is an important cause of treatment‐related mortality and treatment failure in pediatric acute lymphoblastic leukemia (ALL) in... |
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| SubjectTerms | Acute lymphoblastic leukemia Adolescent Age Antibiotics Antineoplastic Combined Chemotherapy Protocols - adverse effects Bacteremia - blood Bacteremia - epidemiology Bacteremia - etiology Bacteria Chemotherapy Child Child, Preschool Childhood Children China - epidemiology Clinical Cancer Research Computer centers Consolidation Chemotherapy - adverse effects Consolidation Chemotherapy - methods Developing countries Disease control Drug resistance E coli Female Females Fungemia - blood Fungemia - epidemiology Fungemia - etiology Fungi Gender Gram-negative bacteria Humans Incidence Induction Chemotherapy - adverse effects Induction Chemotherapy - methods Infant Laboratories LDCs Leukemia Lymphatic leukemia Maintenance Chemotherapy - adverse effects Maintenance Chemotherapy - methods Male Mortality multicenter study Original Research Patients Precursor Cell Lymphoblastic Leukemia-Lymphoma - blood Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality Prospective Studies Retrospective Studies Risk Factors Sepsis Septicemia Sex Factors Streptococcus infections Studies |
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| Title | Septicemia after chemotherapy for childhood acute lymphoblastic leukemia in China: A multicenter study CCCG‐ALL‐2015 |
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