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Prediction of adverse events during intensive induction chemotherapy for acute myeloid leukemia or high‐grade myelodysplastic syndromes
Author(s) -
Buckley Sarah A.,
Othus Megan,
Vainstein Vladimir,
Abkowitz Janis L.,
Estey Elihu H.,
Walter Roland B.
Publication year - 2014
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.23661
Subject(s) - medicine , neutropenia , bacteremia , cytarabine , absolute neutrophil count , induction chemotherapy , myelodysplastic syndromes , febrile neutropenia , myeloid leukemia , chemotherapy regimen , gastroenterology , intensive care unit , adverse effect , chemotherapy , immunology , antibiotics , bone marrow , microbiology and biotechnology , biology
Intensive chemotherapy for newly diagnosed acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS) is associated with significant treatment‐related morbidity and mortality. Herein, we investigate how pretreatment characteristics relate to early adverse outcomes in such patients, studying 205 consecutive individuals receiving curative‐intent induction chemotherapy with cytarabine and an anthracycline (“7 + 3”; n = 175) or a “7 + 3”‐like regimen ( n = 30). Among the entire cohort, baseline grade 4 neutropenia (i.e., absolute neutrophil count <500 cells/µL) was associated with development of fever ( P = 0.04), documented infection ( P < 0.0001), and bacteremia ( P = 0.002) but not requirement for intensive care unit‐level care; after exclusion of the 30 patients who received “7 + 3”‐like induction, baseline grade 4 neutropenia remained associated with documented infection ( P < 0.0001) and bacteremia ( P = 0.0005). Among patients achieving a complete remission with the initial treatment cycle, grade 4 neutropenia was associated with delayed neutrophil count recovery ( P < 0.0001). Low monocyte and lymphocyte counts at baseline were similarly associated with increased risk of documented infection or bacteremia. After adjustment for age, gender, disease type, cytogenetic/molecular risk, and performance status, the risk of fever, documented infection, or bacteremia was 1.87 (95% confidence interval: 1.04–3.34; P =0.04)‐fold, 4.95 (2.20–11.16; P<0.001)‐fold, and 3.14 (0.99–9.98; P =0.05)‐fold higher in patients with initial grade 4 neutropenia. Together, our studies identify severe baseline neutropenia as a risk factor for infection‐associated adverse events after induction chemotherapy and may provide the rationale for the risk‐adapted testing of myeloid growth factor support in this high‐risk AML/MDS patient subset. Am. J. Hematol. 89:423–428, 2014. © 2014 Wiley Periodicals, Inc.