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Trubiano JA, Dickinson M, Thursky KA, Spelman T, Seymour JF, Slavin MA, Worth LJ. Incidence, etiology and timing of infections following azacitidine therapy for myelodysplastic syndromes. Leuk Lymphoma 2017; 58:2379-2386. [PMID: 28278704 DOI: 10.1080/10428194.2017.1295141] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We examine the infective complications occurring during azacitidine (AZA) therapy in patients with myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). A retrospective review of patients receiving ≥1 cycle of AZA for MDS or AML was performed. Patient demographics, infection prophylaxis/episodes and outcomes were evaluated. Sixty eight patients received 884 AZA cycles. Bacterial infections occurred in 25% of cycle-1 and 27% of cycle-2 AZA therapy. Febrile neutropenia complicated 5.3% of AZA cycles, bacteremia 2% and invasive Aspergillosis 0.3%. Using Poisson modeling, a very high IPSS-R (RR 10.26, 95% CI 1.20, 87.41, p= .033) was identified as an independent risk factor for infection. Infection-related attributable mortality was 23%. The burden of infection is high in AZA-treated patients, associated with high attributable mortality. Over 25% of AZA cycles 1 and 2 were complicated by infection, predominantly bacterial, rates dropping to <10% after cycle-5.
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Affiliation(s)
- Jason A Trubiano
- a Department of Infectious Diseases , Peter MacCallum Cancer Centre , East Melbourne , Australia.,b Department of Medicine , University of Melbourne , Melbourne , Australia
| | - Michael Dickinson
- c Department of Haematology , Peter MacCallum Cancer Centre , East Melbourne , Australia
| | - Karin A Thursky
- a Department of Infectious Diseases , Peter MacCallum Cancer Centre , East Melbourne , Australia.,b Department of Medicine , University of Melbourne , Melbourne , Australia.,d Victorian Infectious Diseases Service , Royal Melbourne Hospital at the Peter Doherty Institute , Melbourne , Australia
| | - Timothy Spelman
- b Department of Medicine , University of Melbourne , Melbourne , Australia
| | - John F Seymour
- b Department of Medicine , University of Melbourne , Melbourne , Australia.,c Department of Haematology , Peter MacCallum Cancer Centre , East Melbourne , Australia
| | - Monica A Slavin
- a Department of Infectious Diseases , Peter MacCallum Cancer Centre , East Melbourne , Australia.,b Department of Medicine , University of Melbourne , Melbourne , Australia.,d Victorian Infectious Diseases Service , Royal Melbourne Hospital at the Peter Doherty Institute , Melbourne , Australia
| | - Leon J Worth
- a Department of Infectious Diseases , Peter MacCallum Cancer Centre , East Melbourne , Australia.,b Department of Medicine , University of Melbourne , Melbourne , Australia
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