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Background   Infections are an important cause of morbidity and mortality for acute lymphoblastic leukemia (ALL). However, the reports regarding risk factors of induction-related infection are roughly unknown/limited in adult T-ALL during induction chemotherapy.Methods   We performed a retrospective cohort study for the prevalence and risk predictors of induction-related infection among consecutive T-ALL patients ( N  = 97) enrolled in a PDT-ALL-LBL clinical trial. Of 97 patients with T-ALL enrolled in the trial, 46 were early T-cell precursor (ETP) ALL and 51 were non-ETP ALL.Results   When compared with non-ETP, ETP ALL subtype was characterized with lower neutrophil count (1.35 × 10 9 /L vs. 8.7 × 10 9 /L,  P  < 0.001) and lower myeloid percentage in the bone marrow (13.35% vs. 35.31%,  P  = 0.007). Additionally, ETP ALL had longer neutropenia before diagnosis ( P  < 0.001), as well as during induction chemotherapy ( P  < 0.001). Notably, the ETP cohort experienced higher cumulative incidence of clinically documented infections (CDI; 33.33%,  P  = 0.001), microbiologically documented infections (MDI; 45.24%,  P  = 0.006), resistant infection (11.9%,  P  = 0.013), and mixed infection (21.43%,  P  = 0.003), respectively, than those of the non-ETP cohort. Furthermore, multivariable analysis revealed that T-ALL mixed infection was more likely related to chemotherapy response (OR, 0.025; 95% CI 0.127-0.64;  P  = 0.012) and identified myeloid percentage as a predictor associated with ETP-ALL mixed infection (OR, 0.915; 95% CI 0.843-0.993;  P  = 0.033), with ROC-defined cut-off value of 2.24% in ETP cohorts.Conclusions   Our data for the first time demonstrated that ETP-ALL characterized with impaired myelopoiesis were more susceptible to induction-related infection among T-ALL populations.

Early T-Cell Precursor Leukemia Has a Higher Risk of Induction-Related Infection among T-Cell Acute Lymphoblastic Leukemia in Adult