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Predicting infections in high‐risk patients with myelodysplastic syndrome/acute myeloid leukemia treated with azacitidine: Aretrospective multicenter study
Author(s) -
Merkel Drorit,
Filanovsky Kalman,
GafterGvili Anat,
Vidal Liat,
Aviv Ariel,
Gatt Moshe E.,
Silbershatz Itay,
Herishanu Yair,
Arad Ariela,
Tadmor Tamar,
Dally Najib,
Nemets Anatoly,
Rouvio Ory,
Ronson Aharon,
HerzogTzarfati Katrin,
Akria Luiza,
Braester Andrei,
Hellmann Ilana,
Yeganeh Shay,
Nagler Ar,
Leiba Ronit,
Mittelman Moshe,
Ofran Yishai
Publication year - 2013
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.23368
Subject(s) - medicine , azacitidine , myelodysplastic syndromes , myeloid leukemia , univariate analysis , cytogenetics , absolute neutrophil count , leukemia , incidence (geometry) , gastroenterology , multivariate analysis , neutropenia , chemotherapy , bone marrow , biochemistry , gene expression , chemistry , physics , optics , dna methylation , chromosome , gene
Hypomethylating agents have become the standard therapy for patients with high‐risk myelodysplastic syndrome ( MDS ). In Israel, azacitidine ( AZA ) is routinely used. Yet, infectious complications are common during AZA therapy. The current study was aimed to evaluate the incidence and predisposing risk factors for infections in AZA ‐treated patients. This retrospective study included patients treated with AZA in 18 Israeli medical institutions between 2008 and 2011. Data on 184 patients [157 high‐risk MDS and 27 acute myeloid leukemia ( AML )], with a median age of 71.6 (range 29–92) were recorded. Overall, 153 infectious events were reported during 928 treatment cycles (16.5%) administered to 100 patients. One hundred fourteen, 114/153 (75%) events required hospitalization and 30 (19.6%) were fatal. In a univariate analysis, unfavorable cytogenetics, low neutrophil, hemoglobin ( Hb ) and platelet ( PLT ) counts were found to be associated with infections (24.4% vs. 12.9%, P < 0.0001; 27% vs. 13.5%, P < 0.0001; 20.4% vs. 11%, P < 0.0001 and 29.2% vs. 14.2%, P < 0.0001, respectively). In multivariate analysis, only low Hb level, low PLT count, and unfavorable cytogenetics remained significant. Prior to therapy, poor cytogenetics, PLT count below 20 × 10 9 /L and neutrophil count below 0.5 × 10 9 /L were predictive of the risk of infection during the first two cycles of therapy. In conclusion, patients with unfavorable cytogenetics, presenting with low neutrophil and PLT counts, are susceptible to infections. Evaluation of infection risk should be repeated prior to each cycle. Patients with poor cytogenetics in whom AZA is prescribed despite low PLT count are particularly at high risk for infections and infection prophylaxis may be considered. Am. J. Hematol. 88:130–134, 2013. © 2012 Wiley Periodicals, Inc.