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Childhood leukemia survivors may be at higher risk for infections
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Childhood leukemia survivors demonstrated a higher long-term risk for infections after treatment completion than the general population, according to a study published in the Journal of Clinical Oncology.
“Children who have completed leukemia therapy may remain at higher risk [for] infections, as prior laboratory studies have shown persistent immune dysfunction for months to years after leukemia and chemotherapy,” Marie-Claude Pelland-Marcotte, MD, of the division of hematology/oncology at the Hospital for Sick Children in Toronto, and colleagues wrote. “However, little is known about the epidemiology of infections after therapy completion for childhood leukemia, especially in children who did not undergo hematopoietic stem cell transplantation.”
In the retrospective, population-based cohort study, Pelland-Marcotte and colleagues evaluated 2,204 survivors of childhood acute myelocytic leukemia or acute lymphocytic leukemia diagnosed between 1992 and 2015 in Ontario who were alive and had not relapsed 30 days after completing treatment (index date). The researchers matched the leukemia survivors 5:1 by birth year, sex and rural status with 11,020 controls from the general population. They stratified patients by first-line treatment, including and excluding HSCT.
Time to infections, determined through validated diagnostic codes from administrative databases, served as the study’s primary outcome.
At the index date, median age of survivors and controls was 8 years (interquartile range [IQR], 6-12; 55.6% male).
Researchers followed leukemia survivors for a median 7.2 years (IQR, 2.6-13.8) and controls for a median 9.7 years (IQR, 4.6-15.4), and identified a total of 104,410 infections. Leukemia survivors demonstrated a significantly higher relative rate (RR) of infections than controls overall (RR = 1.51; 95% CI, 1.45-1.57), less than 1 year after index date (RR = 1.77; 95% CI, 1.69-1.86); 1 to 4.99 years after index date (RR = 1.66; 95% CI, 1.62-1.71) and 5 or more years after index date (RR = 1.29; 95% CI, 1.22-1.36).
Among survivors whose original treatment did not include HSCT, the increased rate persisted more than 5 years after index date (RR = 1.29; 95% CI, 1.23-1.35).
Fifty-six deaths occurred during the study period. Leukemia survivors demonstrated significantly higher risk for infection-related mortality, both in the entire cohort (HR = 149.3; 95% CI, 20.4-1,091.9) and among those treated initially with chemotherapy and not HSCT (HR = 92.7; 95% CI, 12.4-690.7).
The researchers acknowledged several limitations to their study, including having no approximation of risk for infection after relapse, reliance on the accuracy of diagnostic codes and a lack of patient-level data on possible risk factors for infections.
“This study found a significant association between a history of leukemia therapy and an increased risk [for] infections,” the researchers wrote. “Additional study is needed to establish whether it is the impact of the leukemia itself or specific treatment exposures that lead to an increased risk [for] late infections.” – by Jennifer Byrne
Disclosure s : The authors report no relevant financial disclosures.
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