{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T12:08:45Z","timestamp":1790856525563,"version":"4.1.0"},"reference-count":46,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp;amp; Cancer"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Infection remains the most common treatment\u2010related toxicity of childhood ALL, emphasizing the need to identify patients at risk and to tailor treatment strategies accordingly.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The primary aim was to compare infectious toxicity during early treatment for childhood ALL following the ALLTogether and NOPHO ALL\u20102008 (ALL\u20102008) protocols, and second, to identify risk factors for infectious toxicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A national retrospective matched cohort study was conducted, including 345 patients aged 1\u201317\u00a0years diagnosed with ALL and treated in Sweden according to the ALLTogether or ALL\u20102008 protocols. Nonparametric tests were used to compare infectious outcomes between protocols, and regression modeling was used to identify risk factors of the infectious outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Treatment following ALL\u20102008 showed higher infectious toxicity during induction, whereas treatment following ALLTogether showed increased infectious toxicity during consolidation 1. Overall, treatment according to ALL\u20102008 was associated with a higher incidence of infections. Anthracycline use and young age (1\u20139\u00a0years) were associated with both higher infectious incidence and more severe infectious complications. Dexamethasone was associated with both lower incidence and lower severity of infectious complications as compared to prednisone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A notable shift in the timing of infectious toxicity was observed between the two treatment protocols. Risk factors for infectious toxicity during early treatment include anthracycline use and young age. Dexamethasone as an induction steroid was associated with lower infectious burden, although its effect is difficult to isolate from the simultaneous anthracycline effect. The findings suggest that treatment composition plays a central role in determining both the extent and timing of infectious complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pbc.32120","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T05:00:10Z","timestamp":1761195610000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Infectious Complications During Early Treatment of Childhood Acute Lymphoblastic Leukemia\u2014A Comparison Between the ALLTogether and NOPHO ALL\u20102008 Protocols"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7563-0261","authenticated-orcid":false,"given":"Hannah","family":"van Bunningen","sequence":"first","affiliation":[{"name":"Department of Women's and Children's Health Unit for Pediatric Oncology Karolinska Institute  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5228-3315","authenticated-orcid":false,"given":"Johannes","family":"Ferm\u00e9r","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health Uppsala University  Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arja","family":"Harila","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health Uppsala University  Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7854-0371","authenticated-orcid":false,"given":"Susanna","family":"Ranta","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health Unit for Pediatric Oncology Karolinska Institute  Stockholm Sweden"},{"name":"Astrid Lindgren Children's Hospital Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Donn\u00e9r","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Wretman","sequence":"additional","affiliation":[{"name":"Crown Princess Victoria Children's Hospital Region \u00d6sterg\u00f6tland  Link\u00f6ping Sweden"},{"name":"Department of Biomedical and Clinical Sciences Link\u00f6ping University  Link\u00f6ping Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hartmut","family":"Vogt","sequence":"additional","affiliation":[{"name":"Crown Princess Victoria Children's Hospital Region \u00d6sterg\u00f6tland  Link\u00f6ping Sweden"},{"name":"Department of Biomedical and Clinical Sciences Link\u00f6ping University  Link\u00f6ping Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3756-8148","authenticated-orcid":false,"given":"Anna S\u00e4llfors","family":"Holmqvist","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Lund University  Lund Sweden"},{"name":"Childhood Cancer Center Sk\u00e5ne University Hospital  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1654-6978","authenticated-orcid":false,"given":"Anders","family":"Valind","sequence":"additional","affiliation":[{"name":"Childhood Cancer Center Sk\u00e5ne University Hospital  Lund Sweden"},{"name":"Department of Laboratory Medicine Division of Clinical Genetics Lund University  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludvig","family":"Henriksson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Ume\u00e5 University Hospital  Ume\u00e5 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Abrahamsson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magnus","family":"Borss\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Ume\u00e5 University Hospital  Ume\u00e5 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5885-7101","authenticated-orcid":false,"given":"Anna","family":"Nilsson","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health Unit for Pediatric Oncology Karolinska Institute  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mats","family":"Heyman","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health Unit for Pediatric Oncology Karolinska Institute  Stockholm Sweden"},{"name":"Astrid Lindgren Children's Hospital Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"NCI \u201cChildhood Acute Lymphoblastic Leukemia Treatment (PDQ): Health Professional Version. PDQ Cancer Information Summaries \u201dNational Cancer Institute (US) 2002."},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)33018-1"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.20501"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.seminhematol.2013.06.007"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcl.2014.09.006"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-03-560847"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2005.05736.x"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jiac.2019.04.005"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2009.12"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.26535"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.21298"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2017.265"},{"key":"e_1_2_10_14_1","unstructured":"\u201cA Treatment Study Protocol of the ALLTogether Consortium for Infants Children and Young Adults (0\u201345\u00a0Years of Age) With Newly Diagnosed Acute Lymphoblastic Leukaemia (ALL): A Pilot Study \u201dNCT 2019 https:\/\/clinicaltrials.gov\/study\/NCT03911128."},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2008-1034450"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2015-09-670729"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.24273"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.61.5187"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(20000415)88:8<1964::AID-CNCR27>3.0.CO;2-1"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.11390"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.13847"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcped.2025.100222"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15235547"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2009.257"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(12)70600-9"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.64.6364"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2002-08-2454"},{"key":"e_1_2_10_28_1","unstructured":"SBCR \u201cSvenska Barncancerregistret \u201dSwedish Childhood Cancer Registry https:\/\/sbcr.se\/."},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2005.05398.x"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcl.2014.09.004"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(00)00314-0"},{"key":"e_1_2_10_33_1","unstructured":"IBM Corp \u201cIBM SPSS Statistics for Windows Version 27.0 \u201dIBM Corp released2020."},{"key":"e_1_2_10_34_1","unstructured":"\u201cInfluenza in Sweden\u2014Season 2020\u20132021; Report No.: 25124 \u201dThe Public Health Agency of Sweden (Folkh\u00e4lsomyndigheten) 2021."},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e3181aa6eae"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1080\/10428194.2020.1852471"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2005.05509.x"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2014.103507"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2022.281788"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.24182"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1080\/10428194.2019.1613537"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.13.8404"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.3109\/10428194.2014.1003056"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V99.6.1986"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41408-018-0084-5"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdw557"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2004.12.043"}],"container-title":["Pediatric Blood &amp; Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pbc.32120","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T12:44:51Z","timestamp":1767962691000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pbc.32120"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,22]]},"references-count":46,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1002\/pbc.32120"],"URL":"https:\/\/doi.org\/10.1002\/pbc.32120","archive":["Portico"],"relation":{},"ISSN":["1545-5009","1545-5017"],"issn-type":[{"value":"1545-5009","type":"print"},{"value":"1545-5017","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,22]]},"assertion":[{"value":"2025-07-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e32120"}}