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Predicting infections in high-risk patients with myelodysplastic syndrome/acute myeloid leukemia treated with azacitidine: Aretrospective multicenter study.
MedLine Citation:
PMID:  23345248     Owner:  NLM     Status:  In-Data-Review    
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.
Drorit Merkel; Kalman Filanovsky; Anat Gafter-Gvili; Liat Vidal; Ariel Aviv; Moshe E Gatt; Itay Silbershatz; Yair Herishanu; Ariela Arad; Tamar Tadmor; Najib Dally; Anatoly Nemets; Ory Rouvio; Aharon Ronson; Katrin Herzog-Tzarfati; Luiza Akria; Andrei Braester; Ilana Hellmann; Shay Yeganeh; Arnon Nagler; Ronit Leiba; Moshe Mittelman; Yishai Ofran
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of hematology     Volume:  88     ISSN:  1096-8652     ISO Abbreviation:  Am. J. Hematol.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610369     Medline TA:  Am J Hematol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  130-4     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Wiley Periodicals, Inc.
Division of Hematology, Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Israel.
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