Effectiveness of supportive care measures to reduce infections in pediatric AML: a report from the Children's Oncology Group.

Objective was to describe the effect of antibiotic and granulocyte colony-stimulating factor (G-CSF) prophylaxis and discharge policy on infection risk and nonrelapse-related mortality (NRM) during chemotherapy for children with acute myeloid leukemia. Patients were non-Down syndrome children enrolled on Children's Oncology Group (COG) trial AAML0531. We surveyed sites to determine institutional standards for systemic antibacterial, antifungal, and G-CSF prophylaxis, and mandatory hospitalization during neutropenia. COG institution survey response rate was 180 of 216 (83.3%). Of 1024 patients enrolled on AAML0531, 897 were non-Down patients from survey-responding institutions. In multiple regression, antibacterial prophylaxis reduced any sterile-site bacterial infection (incidence rate ratio [IRA] 0.85; 95% confidence interval [Cl], 0.72-1.01; P = .058) and Gram-positive sterile-site infection (IRR 0.71; 95% CI, 0.570.90; P = .004). Prophylactic G-CSF reduced bacterial (IRA 0.79; 95% Cl, 0.67-0.92; P = .004) and Clostridium difficile infections (CDls; IRR 0.46; 95% Cl, 0.25-0.84; P = .012). Mandatory hospitalization did not reduce bacterial/fungal infection or significantly [ABSTRACT FROM AUTHOR]