A Study of Infection Profile and Its Association with Induction Outcomes in Newly Diagnosed Childhood Acute Lymphoblastic Leukemia (ALL) at a Tertiary Cancer Center in Northeast India

Acute lymphoblastic leukemia (ALL) is associated with a high risk of infectious complications, particularly during induction chemotherapy. Understanding the infection profile and its impact on treatment outcomes is essential for optimizing supportive care and reducing mortality. The objective of this study is to evaluate the infection profile and its association with induction outcomes in newly diagnosed patients of childhood ALL. This was a retrospective, observational study. All newly diagnosed children with ALL aged 0 to 19 years attending the Pediatric Oncology division at our center with evidence of infection were included. Induction chemotherapy was given as per the modified ALL IC-BFM 2002 protocol. The study period was from July 1, 2022, to October 31, 2023. A total of 122 infectious episodes were identified among 54 included patients. Major sites of infection were the respiratory tract (n = 47) and the gastrointestinal tract (n = 21). Blood cultures were positive in 28 infectious episodes, with predominant isolates being gram-negative organisms (67.85%). Organ dysfunction was observed in 107 (87.70%) infectious episodes, the commonest being the need for non-elective invasive or non-invasive mechanical ventilation in 23 (21.49%). Infection-related mortality (IRM) was observed in 83.33% of the patients, out of the total induction mortality (n = 12/54, 22.22%). Treatment delay of >2 weeks was observed in 38 (70.37%) patients due to infections. Multivariate analysis established a statistically significant association of organ dysfunction, hospitalization >15 days, three or more infectious episodes, with increased IRM, treatment delay of more than 2 weeks, higher age group (12–17 years), male gender, and high-risk group patients. Infections were a major cause of treatment delay and mortality in pediatric patients with ALL during induction chemotherapy. Identification of risk factors for infections, as well as IRM, careful monitoring, and early intervention with optimal antibiotics and supportive care can improve outcomes.