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Czech MM, Schulz E, Mina A, Gea-Banacloche J. Infections and antimicrobial prophylaxis in patients with myelodysplastic syndromes. Semin Hematol 2024:S0037-1963(24)00085-4. [PMID: 39198132 DOI: 10.1053/j.seminhematol.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 07/29/2024] [Indexed: 09/01/2024]
Abstract
Infectious complications are an important cause of morbidity and mortality in patients with myelodysplastic syndromes (MDS). Preventing infections could significantly improve both survival and quality of life. Unfortunately, both infections and antimicrobial prophylaxis in patients with MDS are incompletely assessed due to the heterogeneity of disorders included in each publication, changing definitions over time, and lack of standardized prophylaxis practices. Despite these limitations, some basic statements can be made. Infections in MDS are associated with neutropenia. Patients with lower-risk (LR) MDS tend to have fewer infections compared to patients with higher-risk (HR) MDS, which may be related to the different prevalence of neutropenia in the 2 groups. Pneumonia is the most common infection, and bacteria are the most common pathogens. Invasive fungal infections (IFI) are uncommon. Reactivation of latent viruses are rare. With the limited data available, we agree that antibacterial prophylaxis can be considered in patients with HR-MDS during severe neutropenia and early cycles of therapy when infections are most likely to occur. Given the low prevalence of IFI and viral reactivation, antimicrobial prophylaxis for these pathogens is less likely to be advantageous for most patients, although antifungal prophylaxis with activity against mold is commonly used in patients with persistent, profound neutropenia. Ultimately, improved data collection regarding infections and antimicrobial prophylaxis is needed to improve care for patients with MDS.
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Affiliation(s)
- Mary M Czech
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.
| | - Eduard Schulz
- Myeloid Malignancy Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Alain Mina
- Myeloid Malignancy Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Juan Gea-Banacloche
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
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Shimaya M, Inagaki Y, Arai T, Kawakami M, Takeuchi N, Sumikawa H, Shimizu S, Takimoto T, Inoue Y. Autoimmune Pulmonary Alveolar Proteinosis Complicated by Myelodysplastic Syndrome. Intern Med 2024; 63:1451-1457. [PMID: 37839886 PMCID: PMC11157314 DOI: 10.2169/internalmedicine.1982-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/01/2023] [Indexed: 10/17/2023] Open
Abstract
Pulmonary alveolar proteinosis (PAP) is characterized by an abnormal surfactant accumulation in peripheral air spaces. Autoimmune PAP (APAP) results from macrophage dysfunction caused by anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) autoantibodies, and the presence of antibodies more than the cutoff value is specific for APAP. In contrast, secondary PAP (SPAP) does not require anti-GM-CSF autoantibodies and is complicated by other diseases, including myelodysplastic syndrome (MDS). A 73-year-old man with anemia and thrombocytopenia was diagnosed with APAP and MDS simultaneously. The measurement of serum anti-GM-CSF autoantibodies is important for the correct diagnosis and management of PAP, even with an established diagnosis of underlying SPAP-suggestive disease.
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Affiliation(s)
- Minako Shimaya
- Department of Internal Medicine, NHO Kinki Chuo Chest Medical Center, Japan
| | - Yuji Inagaki
- Department of Internal Medicine, NHO Kinki Chuo Chest Medical Center, Japan
| | - Toru Arai
- Clinical Research Center, NHO Kinki Chuo Chest Medical Center, Japan
| | - Mayu Kawakami
- Department of Internal Medicine, NHO Kinki Chuo Chest Medical Center, Japan
| | - Naoko Takeuchi
- Department of Internal Medicine, NHO Kinki Chuo Chest Medical Center, Japan
| | | | - Shigeki Shimizu
- Department of Pathology, NHO Kinki Chuo Chest Medical Center, Japan
| | - Takayuki Takimoto
- Department of Internal Medicine, NHO Kinki Chuo Chest Medical Center, Japan
| | - Yoshikazu Inoue
- Clinical Research Center, NHO Kinki Chuo Chest Medical Center, Japan
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3
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Scamuffa MC, Latagliata R, Carmosino I, Di Veroli A, Scalzulli E, Trapè G, Ciotti G, De Angelis G, Tartaglia G, Tarnani M, Breccia M, Girmenia C. Pulmonary infections in patients with acute myeloid leukemia receiving frontline treatment with hypomethylating agents. Leuk Lymphoma 2023; 64:1840-1846. [PMID: 37554018 DOI: 10.1080/10428194.2023.2239407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 08/10/2023]
Abstract
Pulmonary infections (PIs) are a major complication of Acute Myeloid Leukemia (AML) treated with hypomethylating agents (HMA). We retrospectively evaluated 147 AML patients treated frontline with HMA in 2 Centers. Total number of HMA cycles was 1397. There were 88 episodes of PI in 64 patients (43.5%). Thirty-five/147 patients at risk (23.8%) developed at least 1 episode of early PI (during cycles 1-2). Median OS in patients who developed early PI was 3.3 months (95% CI 0.8 - 5.8) versus 10.5 months (95% CI 8.4 - 12.7) in patients without PI or with PI beyond the 2nd cycle (p < .001). Early PIs were an independent factor predicting lower survival (OR 1.94, 95% CI 1.28 - 2.93; p = .002). In conclusion, early PIs are common in AML patients receiving HMA and are associated with an unfavorable outcome. The results of our study raise the issue of a tailored infection prevention strategy.
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Affiliation(s)
- Maria Cristina Scamuffa
- Hematology, Department of Translational and Precision Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Ida Carmosino
- Hematology, Department of Translational and Precision Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Emilia Scalzulli
- Hematology, Department of Translational and Precision Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Giulia Ciotti
- Hematology, Department of Translational and Precision Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Germana Tartaglia
- Hematology, Department of Translational and Precision Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Corrado Girmenia
- Hematology, Department of Translational and Precision Medicine, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Wang ST, Chou CH, Chen TT, Lin CC, Bai LY, Yeh SP, Ho MW, Lien MY. High rate of invasive fungal infections during early cycles of azacitidine for patients with acute myeloid leukemia. Front Cell Infect Microbiol 2022; 12:1012334. [PMID: 36530436 PMCID: PMC9748082 DOI: 10.3389/fcimb.2022.1012334] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/07/2022] [Indexed: 12/05/2022] Open
Abstract
Background Acute myeloid leukemia (AML) is a form of cancer that is characterized by infiltration of the bone marrow, blood, and other tissues by proliferative, clonal, abnormally differentiated, and occasionally poorly differentiated cells of the hematopoietic system. Patients with acute myeloid leukemia (AML) receiving azacitidine (AZA) alone or in combination with venetoclax (VEN-AZA) are at increased risk for invasive fungal infections (IFIs). We compared the incidence and risk of IFI during these treatment regimens in a single Taiwan hospital. Materials and methods A total of 61 patients with AML received at least one course of AZA in the hematology ward of China Medical University Hospital (Taichung, Taiwan) between September 2012 and June 2020. Thirty-eight patients (62.3%) received AZA monotherapy; 23 (37.7%) received VEN-AZA. Results Incidence rates of probable and proven IFI were 18% and 1.6%, respectively, during AZA treatment. One proven case of Fusarium spp. infection was isolated by skin and soft tissue culture. Most (75%) IFI cases occurred during the first cycle of AZA therapy. Half of all IFI cases occurred in patients with prolonged neutropenia. The risk of IFI was significantly higher for the European LeukemiaNet (ELN) nonfavorable-risk group (intermediate- and adverse-risk group) versus the ELN favorable-risk group and for patients with prolonged neutropenia versus those without (P<0.05 for both comparisons). In this study, median OS did not differ significantly between patients with and without IFIs during AZA-containing regimens (14.6 months vs 13.7 months; P=0.59). Conclusion The incidence of IFI was high in this AML cohort treated with AZA-containing regiments in Taiwan. The majority of IFI cases occurred during the early cycles of AZA (cycles 1-2). Prospective studies are needed to determine the optimal choice of antifungal prophylaxis agent during VEN-AZA therapy for AML.
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Affiliation(s)
- Sing-Ting Wang
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Huei Chou
- Division of Infection Disease, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Tzu-Ting Chen
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ching-Chan Lin
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Li-Yuan Bai
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan,Department of Internal Medicine, Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan
| | - Shih-Peng Yeh
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan,Department of Internal Medicine, Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan
| | - Mao-Wang Ho
- Division of Infection Disease, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Yu Lien
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan,Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan,*Correspondence: Ming-Yu Lien,
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Rozema J, Hoogendoorn M, Potma I, ten Seldam I, Veeger NJGM, Kibbelaar RE, van de Loosdrecht AA, van Roon EN. Increased prescription rate of anti-infective agents after diagnosis of myelodysplastic syndromes. EJHAEM 2022; 3:775-784. [PMID: 36051088 PMCID: PMC9422012 DOI: 10.1002/jha2.422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 12/21/2022]
Abstract
The a priori risk for infections in patients with myelodysplastic syndromes (MDS) is unknown. This study examines prescription rates of anti-infective agents in MDS patients before and after diagnosis, in both in- and outpatient settings, to provide information on infection management in clinical practice. We performed a population-based study using the HemoBase registry, containing data of all MDS patients diagnosed since 2005 in Friesland, the Netherlands. Community and hospital pharmacies provided prescription data from 1995 to 2020. Data were obtained for 203 of 292 patients (70%). Patients received significantly more anti-infective agents, predominantly antibacterials (70%), after diagnosis compared to before: 148.7 defined daily dose/1000 days (DID) (95% CI: 146.9-150.5) and 55.1 DID (95% CI: 54.5-55.8, p < 0.01), respectively, corresponding to median 23.5 and 7.6 treatment days/year. Higher-risk (449.9 DID) and lower-risk patients (129.1 DID) both received significantly more anti-infective agents after diagnosis; comorbidities, neutropenia, and age did not show significant differences relative to prescription rates. Before diagnosis, 10% of patients had infection-related hospital admissions versus 38% after diagnosis. In conclusion, MDS patients received significantly more anti-infective agents compared to before diagnosis. This is the first study that has quantified the prescription rate of anti-infective agents within and beyond the clinical setting in MDS.
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Affiliation(s)
- Johanne Rozema
- Unit of PharmacotherapyEpidemiology and EconomicsDepartment of PharmacyUniversity of GroningenGroningenThe Netherlands
- Department of Clinical Pharmacy and PharmacologyMedical Centre LeeuwardenLeeuwardenThe Netherlands
| | - Mels Hoogendoorn
- Department of Internal MedicineMedical Centre LeeuwardenLeeuwardenThe Netherlands
| | - Iris Potma
- Unit of PharmacotherapyEpidemiology and EconomicsDepartment of PharmacyUniversity of GroningenGroningenThe Netherlands
| | - Inge ten Seldam
- Unit of PharmacotherapyEpidemiology and EconomicsDepartment of PharmacyUniversity of GroningenGroningenThe Netherlands
| | - Nic J. G. M. Veeger
- Science BureauMedical Centre LeeuwardenLeeuwardenThe Netherlands
- Department of EpidemiologyUniversity of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
| | | | | | - Eric N. van Roon
- Unit of PharmacotherapyEpidemiology and EconomicsDepartment of PharmacyUniversity of GroningenGroningenThe Netherlands
- Department of Clinical Pharmacy and PharmacologyMedical Centre LeeuwardenLeeuwardenThe Netherlands
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SARS-CoV-2 in Myelodysplastic Syndromes: A Snapshot From Early Italian Experience. Hemasphere 2020; 4:e483. [PMID: 33062948 PMCID: PMC7523798 DOI: 10.1097/hs9.0000000000000483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/10/2020] [Indexed: 11/25/2022] Open
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