Septicemia after chemotherapy for childhood acute lymphoblastic leukemia in China: A multicenter study CCCG‐ALL‐2015

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.

BRD4 PROTAC degrader ARV-825 inhibits T-cell acute lymphoblastic leukemia by targeting 'Undruggable' Myc-pathway genes

“…00737290; Thermo Fisher Scientific, Waltham, MA, USA), according to the manual, were used to detect BRD4 mRNA expression via real-time polymerase chain reaction (PCR). Samples from two patients with primary T-ALL who participated in the CCCG 2015 protocol [ 21 ] were collected for cell viability and western blot analysis.…”

Population Pharmacokinetics of High-Dose Methotrexate in Chinese Pediatric Patients With Acute Lymphoblastic Leukemia

“…The pediatric patients with ALL were diagnosed and treated in accordance to the guidelines outlined in the China Children's Leukemia Group (CCLG) ALL-2008 protocol (Cui et al, 2018) and China Children's Cancer Group (CCCG) ALL-2015 protocol (Zhu et al, 2020). Children diagnosed with ALL were classified into the low-risk (LR), intermediate-risk (IR), and high-risk (HR) groups.…”

Hypertension in Pediatric Acute Lymphoblastic Leukemia Patients: Prevalence, Impact, and Management Strategies

“… 6 Patients with ALL are also at increased risk of sepsis, which greatly increases risk of AKI. 23 , 24 Renal leukemic infiltration has also been identified as a risk factor in HTN development for these patients; however, in one study only 15.6% of patients with renal leukemic infiltration suffered from HTN, suggesting that renal leukemic infiltration alone is not causative. 6 Nevertheless, these are some of the more significant factors that suggest that the leukemic process itself may be an important contributing etiologic factor.…”