Clinical Characteristics and Risk Factors of Acute Lymphoblastic Leukemia Children Complicated with Severe Infection during the Maintenance treatment

Abstract

Abstract Purpose Infection is the most common adverse event of acute lymphoblastic leukemia (ALL) treatment and also one of the main causes of death. To investigate the clinical characteristics and risk factors of severe infection during the maintenance phase of ALL treatment, we conducted a retrospective study. Methods We collected clinical data of ALL children, and analyzed the clinical features and risk factors of severe infection by χ2 test and binary Logistic regression. Results A total of 181 children were eligible, and 46 patients (25.4%) suffered from 51 events of severe infection, most of which occurred in the first half year of the maintenance phase (52.9%). The most common infection was pulmonary infection (86.3%) and followed by bloodstream infection (19.6%). The positive rate of pathogen detection was low (17.6%, 44/250), and the most common one was fungal infection. The main symptoms of ALL patients with pulmonary infection were fever, cough and shortness of breath. The main manifestations of CT were ground glass shadow (56.8%), consolidation shadow (27.3%) and streak shadow (25%). Binary logistic regression analysis showed that agranulocytosis, agranulocytosis ≥ 7 days, anemia and low globulin level were independent risk factors for severe infection during the maintenance phase (all P < 0.05). Conclusion Blood routine examinations and protein levels should be monitored regularly for ALL patients in the maintenance phase, especially in the first six months. For ALL patients with the risk factors, preventive anti-infective therapy or supportive therapy can be given as appropriate to reduce the occurrence of severe infection.