TY - JOUR
T1 - Predicting infections in high-risk patients with myelodysplastic syndrome/acute myeloid leukemia treated with azacitidine
T2 - Aretrospective multicenter study
AU - Merkel, Drorit
AU - Filanovsky, Kalman
AU - Gafter-Gvili, Anat
AU - Vidal, Liat
AU - Aviv, Ariel
AU - Gatt, Moshe E.
AU - Silbershatz, Itay
AU - Herishanu, Yair
AU - Arad, Ariela
AU - Tadmor, Tamar
AU - Dally, Najib
AU - Nemets, Anatoly
AU - Rouvio, Ory
AU - Ronson, Aharon
AU - Herzog-Tzarfati, Katrin
AU - Akria, Luiza
AU - Braester, Andrei
AU - Hellmann, Ilana
AU - Yeganeh, Shay
AU - Nagler, Arnon
AU - Leiba, Ronit
AU - Mittelman, Moshe
AU - Ofran, Yishai
PY - 2013/2/1
Y1 - 2013/2/1
N2 - 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 × 109/L and neutrophil count below 0.5 × 109/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.
AB - 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 × 109/L and neutrophil count below 0.5 × 109/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.
UR - http://www.scopus.com/inward/record.url?scp=84872924343&partnerID=8YFLogxK
U2 - 10.1002/ajh.23368
DO - 10.1002/ajh.23368
M3 - Article
C2 - 23345248
AN - SCOPUS:84872924343
SN - 0361-8609
VL - 88
SP - 130
EP - 134
JO - American Journal of Hematology
JF - American Journal of Hematology
IS - 2
ER -