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.
OBJECTIVE
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.
Malagola
Michele
M
Unit of Blood Diseases and Cell Therapies, University of Brescia, Brescia, Italy. michelemalagola@yahoo.it
Peli
Annalisa
A
Damiani
Daniela
D
Candoni
Anna
A
Tiribelli
Mario
M
Martinelli
Giovanni
G
Piccaluga
Pier Paolo
PP
Paolini
Stefania
S
De Rosa
Francesco
F
Lauria
Francesco
F
Bocchia
Monica
M
Gobbi
Marco
M
Pierri
Ivana
I
Zaccaria
Alfonso
A
Zuffa
Eliana
E
Mazza
Patrizio
P
Priccolo
Giancarla
G
Gugliotta
Luigi
L
Bonini
Alessandro
A
Visani
Giuseppe
G
Skert
Cristina
C
Bergonzi
Cesare
C
Roccaro
Aldo Maria
AM
Filì
Carla
C
Fanin
Renato
R
Baccarani
Michele
M
Russo
Domenico
D
D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016470:Bacteremia / Q000139:chemically induced / Q000401:mortality; D005260:Female; D005334:Fever / Q000139:chemically induced / Q000401:mortality; D016905:Gram-Negative Bacterial Infections / Q000139:chemically induced / Q000401:mortality*; D016908:Gram-Positive Bacterial Infections / Q000139:chemically induced / Q000401:mortality*; D006801:Humans; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000139:chemically induced / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014740:Vidarabine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
D000970:Antineoplastic Agents; D014740:Vidarabine; C024352:fludarabine