Viral Infection Profile in Children Treated for Acute Lymphoblastic Leukemia—Results of Nationwide Study

Abstract

Viral infections can be a serious complication of therapy in children with acute lymphoblastic leukemia (ALL). In this study, we focused on the incidence and the profile of viral infection in children with ALL treated in 17 pediatric oncology centers in Poland in the two-year periods of 2018–2019 and 2020–2021. We also compared the frequency of viral infections in 2018–2019 to that in 2020–2021. In 2020–2021, a total of 192 children with ALL had a viral infection during intensive chemotherapy. A total number of 312 episodes of viral infections were diagnosed. The most common infections detected in the samples were: COVID-19 (23%), rhinovirus (18%), and respiratory syncytial virus (14%). COVID-19 and BK virus infections were the reason for the death 1% of all patients. In 2018–2019, a total of 53 ALL patients who had a viral infection were reported and 72 viral events were observed, mainly adenovirus (48.6%), rotavirus (31.9%), and herpes zoster (8.3%). No deaths were reported during this period. The cumulative incidence of viral infections in 2018–2019 was 10.4%, while for 2020–2021, it was 36.7%. In conclusion, a high incidence of COVID-19 infection was observed among pediatric patients with ALL in Poland. The mortality rate in our material was low. The viral profile in ALL children undergoing chemotherapy can be useful for clinicians to improve prophylactic and therapeutic strategies.

Treatment-related mortality in the course of acute lymphoblastic leukemia – case report

“…The main pathogens causing infections in children during ALL treatment are bacteria (53% of children), fungi (20%) and viruses (18-35%) [15,16]. Among bacteria, the most common infections resulting in IRM, according to O'Connor et al, were caused by Gram-negative bacteria (64%), and of these -P. aeruginosa (22%) and E. coli (20%) [4].…”

“…Among viruses, COVID-19 (23%), rhinovirus (18%) and RSV (14%) were the most frequently observed in recent years (from 2020). In the pre-pandemic era (2018-2019), the most common infections were caused by adenoviruses (49%), rotavirus (32%) and VZV (8%) [16]. In the case of IRM, the most common viruses isolated were adenoviruses (43%), VZV (29%) and RSV (28%), accounting for 12% of deaths due to infections in the course of ALL [4].…”

Incidence of bacterial and fungal infections in Polish pediatric patients with acute lymphoblastic leukemia during the pandemic

“…Risk factors for the development of infections in patients undergoing anticancer therapy include Caucasian race, female sex, age (higher risk in infants and adolescents), Down syndrome, steroid use, the presence of a central venous catheter, and a prolonged neutropenic phase 2 , 4 , 5 . The need to reduce the dose of cytostatic drugs or even stop anticancer treatment due to infection may significantly increase the risk of relapse 6 – 8 . It is very important to be aware of the types of pathogens that cause infection in children and adolescents with ALL to establish infection prophylaxis strategies, including bacterial and fungal infection prevention.…”

“…Additionally, we compared these results with those of our previous study, which we conducted in the years 2012–2017. Data on viral infections for 2020–2021 were published elsewhere 8 .…”