Abstract
Objectives: Infections are the major cause of morbidity and mortality in patients with acute myeloid leukaemia (AML). They primarily occur during the first course of induction chemotherapy and may increase the risk of leukaemia relapse, due to a significant delay in consolidation therapy. The intensification of induction chemotherapy and the use of non-conventional drugs such as fludarabine are considered responsible for the increased risk of infections. Methods: In this study, we retrospectively analysed the infections occurred in 224 newly diagnosed AML patients ≤65 yr, consecutively treated between 1997 and 2002 with an induction regimen including fludarabine, arabinosyl cytosine and idarubicin, with or without etoposide (FLAI/FLAIE), in the context of three multicentric prospective trials (AML97, AML99, AML02). Results: During the induction phase, 146 (65%) patients experienced fever of undetermined origin (FUO), 30 (13%) and 47 (21%) patients had Gram-negative and positive bacteremias, respectively, and 10 (4%) patients developed a probable/proven invasive fungal infection (IFI). The fatality rate for Gram-negative, Gram-positive bacteremias and probable/proven IFI was 10%, 8% and 60% respectively. During consolidation, 75 (35%) patients had FUO, 43 (20%) and 40 (19%) patients had Gram-negative and positive bacteremias, respectively, and 5 (2%) patients developed a probable/proven IFI. The fatality rate for Gram-negative, Gram-positive bacteremias and probable/proven IFI was 14%, 5% and 80% respectively. Interestingly, the overall incidence of microbiologically documented infections during induction was 38% and the incidence of probable/proven IFIs during the induction/consolidation programme was 7%. No infections caused by viruses or opportunistic pathogens were observed neither during induction, nor during consolidation. Conclusions: These data, although retrospectively collected, suggest that fludarabine-based chemotherapy is not associated with an increased incidence of infections, in particular IFIs, compared to conventional regimens commonly used for AML induction.
| Original language | English |
|---|---|
| Pages (from-to) | 354-363 |
| Number of pages | 10 |
| Journal | European Journal of Haematology |
| Volume | 81 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - Nov 2008 |
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Keywords
- Acute leukaemia
- Fever
- Fludarabine
- Induction
- Infections
ASJC Scopus subject areas
- Hematology
Cite this
Incidence of bacterial and fungal infections in newly diagnosed acute myeloid leukaemia patients younger than 65 yr treated with induction regimens including fludarabine : Retrospective analysis of 224 cases. / Malagola, Michele; Peli, Annalisa; Damiani, Daniela; Candoni, Anna; Tiribelli, Mario; Martinelli, Giovanni; Piccaluga, Pier Paolo; Paolini, Stefania; De Rosa, Francesco; Lauria, Francesco; Bocchia, Monica; Gobbi, Marco; Pierri, Ivana; Zaccaria, Alfonso; Zuffa, Eliana; Mazza, Patrizio; Priccolo, Giancarla; Gugliotta, Luigi; Bonini, Alessandro; Visani, Giuseppe; Skert, Cristina; Bergonzi, Cesare; Roccaro, Aldo Maria; Filì, Carla; Fanin, Renato; Baccarani, Michele; Russo, Domenico.
In: European Journal of Haematology, Vol. 81, No. 5, 11.2008, p. 354-363.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Incidence of bacterial and fungal infections in newly diagnosed acute myeloid leukaemia patients younger than 65 yr treated with induction regimens including fludarabine
T2 - Retrospective analysis of 224 cases
AU - Malagola, Michele
AU - Peli, Annalisa
AU - Damiani, Daniela
AU - Candoni, Anna
AU - Tiribelli, Mario
AU - Martinelli, Giovanni
AU - Piccaluga, Pier Paolo
AU - Paolini, Stefania
AU - De Rosa, Francesco
AU - Lauria, Francesco
AU - Bocchia, Monica
AU - Gobbi, Marco
AU - Pierri, Ivana
AU - Zaccaria, Alfonso
AU - Zuffa, Eliana
AU - Mazza, Patrizio
AU - Priccolo, Giancarla
AU - Gugliotta, Luigi
AU - Bonini, Alessandro
AU - Visani, Giuseppe
AU - Skert, Cristina
AU - Bergonzi, Cesare
AU - Roccaro, Aldo Maria
AU - Filì, Carla
AU - Fanin, Renato
AU - Baccarani, Michele
AU - Russo, Domenico
PY - 2008/11
Y1 - 2008/11
N2 - Objectives: Infections are the major cause of morbidity and mortality in patients with acute myeloid leukaemia (AML). They primarily occur during the first course of induction chemotherapy and may increase the risk of leukaemia relapse, due to a significant delay in consolidation therapy. The intensification of induction chemotherapy and the use of non-conventional drugs such as fludarabine are considered responsible for the increased risk of infections. Methods: In this study, we retrospectively analysed the infections occurred in 224 newly diagnosed AML patients ≤65 yr, consecutively treated between 1997 and 2002 with an induction regimen including fludarabine, arabinosyl cytosine and idarubicin, with or without etoposide (FLAI/FLAIE), in the context of three multicentric prospective trials (AML97, AML99, AML02). Results: During the induction phase, 146 (65%) patients experienced fever of undetermined origin (FUO), 30 (13%) and 47 (21%) patients had Gram-negative and positive bacteremias, respectively, and 10 (4%) patients developed a probable/proven invasive fungal infection (IFI). The fatality rate for Gram-negative, Gram-positive bacteremias and probable/proven IFI was 10%, 8% and 60% respectively. During consolidation, 75 (35%) patients had FUO, 43 (20%) and 40 (19%) patients had Gram-negative and positive bacteremias, respectively, and 5 (2%) patients developed a probable/proven IFI. The fatality rate for Gram-negative, Gram-positive bacteremias and probable/proven IFI was 14%, 5% and 80% respectively. Interestingly, the overall incidence of microbiologically documented infections during induction was 38% and the incidence of probable/proven IFIs during the induction/consolidation programme was 7%. No infections caused by viruses or opportunistic pathogens were observed neither during induction, nor during consolidation. Conclusions: These data, although retrospectively collected, suggest that fludarabine-based chemotherapy is not associated with an increased incidence of infections, in particular IFIs, compared to conventional regimens commonly used for AML induction.
AB - Objectives: Infections are the major cause of morbidity and mortality in patients with acute myeloid leukaemia (AML). They primarily occur during the first course of induction chemotherapy and may increase the risk of leukaemia relapse, due to a significant delay in consolidation therapy. The intensification of induction chemotherapy and the use of non-conventional drugs such as fludarabine are considered responsible for the increased risk of infections. Methods: In this study, we retrospectively analysed the infections occurred in 224 newly diagnosed AML patients ≤65 yr, consecutively treated between 1997 and 2002 with an induction regimen including fludarabine, arabinosyl cytosine and idarubicin, with or without etoposide (FLAI/FLAIE), in the context of three multicentric prospective trials (AML97, AML99, AML02). Results: During the induction phase, 146 (65%) patients experienced fever of undetermined origin (FUO), 30 (13%) and 47 (21%) patients had Gram-negative and positive bacteremias, respectively, and 10 (4%) patients developed a probable/proven invasive fungal infection (IFI). The fatality rate for Gram-negative, Gram-positive bacteremias and probable/proven IFI was 10%, 8% and 60% respectively. During consolidation, 75 (35%) patients had FUO, 43 (20%) and 40 (19%) patients had Gram-negative and positive bacteremias, respectively, and 5 (2%) patients developed a probable/proven IFI. The fatality rate for Gram-negative, Gram-positive bacteremias and probable/proven IFI was 14%, 5% and 80% respectively. Interestingly, the overall incidence of microbiologically documented infections during induction was 38% and the incidence of probable/proven IFIs during the induction/consolidation programme was 7%. No infections caused by viruses or opportunistic pathogens were observed neither during induction, nor during consolidation. Conclusions: These data, although retrospectively collected, suggest that fludarabine-based chemotherapy is not associated with an increased incidence of infections, in particular IFIs, compared to conventional regimens commonly used for AML induction.
KW - Acute leukaemia
KW - Fever
KW - Fludarabine
KW - Induction
KW - Infections
UR - http://www.scopus.com/inward/record.url?scp=54349092650&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=54349092650&partnerID=8YFLogxK
U2 - 10.1111/j.1600-0609.2008.01122.x
DO - 10.1111/j.1600-0609.2008.01122.x
M3 - Article
C2 - 18637030
AN - SCOPUS:54349092650
VL - 81
SP - 354
EP - 363
JO - European Journal of Haematology
JF - European Journal of Haematology
SN - 0902-4441
IS - 5
ER -