School of Medicine

Background : While overall 5-year survival has improved by approximately 50% in pediatric AML patients in the last twenty years with intensification of antineoplastic therapy and advancement in antimicrobial therapy, treatment-related complications continue to be a major problem. Prior studies have demonstrated that mandatory hospitalization during profound neutropenia did not reduce infections or significantly reduce nonrelapse mortality (NRM). The aim of this study was to evaluate the effect of our supportive care measures on treatment-related mortality (TRM), event free survival (EFS), and overall survival (OS). Secondary aims of this study were to document infectious complications of AML therapy, which organisms were isolated most frequently from blood cultures, quantify the number of antibiotic modifications made for each patient throughout treatment and observe how many patients were admitted to the pediatric intensive care unit (PICU) for septic shock and acute respiratory distress syndrome (ARDS). Methods and Materials : A retrospective chart review of 35 pediatric AML patients treated at Rady Children's Hospital of San Diego (RCHSD) from January 2006 and July 2013 were examined. The OS, EFS and TRM were determine for this cohort and compared to the outcomes of those pediatric AML patients treated under the Children's Oncology Group (COG) AAML0531 and CCG2961. Results : Of the 35 patients analyzed, the OS for AML patients treated at RCHSD was 75%, EFS was 59% and TRM was calculated as 3%. These values were compared to the OS, EFS and TRM of patients treated on the COG AAML0531 and CCG2961 protocols. Only one individual died from treatment related causes making TRM 3%. Additionally, infectious complications were also examined and among this cohort of patients, bacteremia (46.7%) and diarrhea due to C. difficile (16.5%) were the most common infectious complications throughout treatment. Of the organisms that grew from blood cultures, Streptococcus viridans (22%) and Staphylococcus epidermidis (20%) were th.