title: Higher infection rate after 7- compared with 5-day cycle of azacitidine in patients with higher-risk myelodysplastic syndrome.
abstract: BACKGROUND
  Azacitidine (AZA) dose reduction is a common practice in cytopenic patients. However, a correlation between AZA dose and infection complications has never been studied.
  
  
  METHODS
  Higher-risk patients with myelodysplastic syndrome or acute myeloid leukemia treated with AZA in 18 Israeli hospitals between the years 2008 and 2011 were included in a former national survey. To reveal the effect of AZA dosage on infection risk we limited our analysis to the infection rate after the first AZA dose alone. We excluded subsequent cycles of AZA from the analysis, because infectious events during these cycles might be related to other cofactors such as disease response to AZA therapy.
  
  
  RESULTS
  After the first AZA cycle, infectious events were more frequent after doses of 75 mg/m(2) for 7 days than 75 mg/m(2) for 5 days (36/106 [34%] and 10/67 [14.9%], respectively; P = .008), regardless of the patient's age. Of the 46 recorded infectious events, the causative pathogen was identified as bacterial in 25 (54.3%) and as viral or fungal in 2 (4.3%) and 2 (4.3%) cases, respectively. No pathogen was identified in 17 (37%) cases. Infections were significantly more prevalent among patients who presented with platelet counts < 20,000 (43.6% vs. 23.6%; P = .012) and poor risk cytogenetics (40.7% vs. 19.8%; P = .008).
  
  
  CONCLUSIONS
  Reduction of AZA dose might decrease infection rate and therefore should be considered in patients with high infection risk.
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. Electronic address: y_ofran@rambam.health.gov.il.
authors.forename: Yishai
authors.initials: Y
authors.lastname: Ofran
authors.affiliation: Department of Hematology, Kaplan Medical Center, Rehovot, Israel.
authors.forename: Kalman
authors.initials: K
authors.lastname: Filanovsky
authors.affiliation: Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Anat
authors.initials: A
authors.lastname: Gafter-Gvili
authors.affiliation: Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Liat
authors.initials: L
authors.lastname: Vidal
authors.affiliation: Department of Hematology, Emek Medical Center, Afula, Israel.
authors.forename: Ariel
authors.initials: A
authors.lastname: Aviv
authors.affiliation: Hematology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Moshe E
authors.initials: ME
authors.lastname: Gatt
authors.affiliation: Hematology Institute, Wolfson Medical Center, Holon, Israel.
authors.forename: Itay
authors.initials: I
authors.lastname: Silbershatz
authors.affiliation: Hematology Institute, Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Yair
authors.initials: Y
authors.lastname: Herishanu
authors.affiliation: Department of Hematology, Sanz Medical Center - Laniado Hospital, Netanya, Israel.
authors.forename: Ariela
authors.initials: A
authors.lastname: Arad
authors.affiliation: Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel; Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel.
authors.forename: Tamar
authors.initials: T
authors.lastname: Tadmor
authors.affiliation: Department of Hematology, Ziv Medical Center, Zefat, Israel.
authors.forename: Najib
authors.initials: N
authors.lastname: Dally
authors.affiliation: Department of Hematology, Barzilai Medical Center, Ashkelon, Israel.
authors.forename: Anatoly
authors.initials: A
authors.lastname: Nemets
authors.affiliation: Institution of Hematology, Soroka University Medical Center, Beer-Sheba, Israel.
authors.forename: Ory
authors.initials: O
authors.lastname: Rouvio
authors.affiliation: Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Aharon
authors.initials: A
authors.lastname: Ronson
authors.affiliation: Hematology Unit, Assaf Harofe Medical Center, Zerifin, Israel.
authors.forename: Katrin
authors.initials: K
authors.lastname: Herzog-Tzarfati
authors.affiliation: Department of Hematology, Western Galilee Hospital, Nahariya, Israel.
authors.forename: Luiza
authors.initials: L
authors.lastname: Akria
authors.affiliation: Department of Hematology, Western Galilee Hospital, Nahariya, Israel.
authors.forename: Andrei
authors.initials: A
authors.lastname: Braester
authors.affiliation: Hematology Unit, Meir Medical Center, Kfar Saba, Israel.
authors.forename: Ilana
authors.initials: I
authors.lastname: Hellmann
authors.affiliation: Hematology Unit, Poria Medical Center, Hedera, Israel.
authors.forename: Shay
authors.initials: S
authors.lastname: Yeganeh
authors.affiliation: Division of Hematology, Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Arnon
authors.initials: A
authors.lastname: Nagler
authors.affiliation: Quality of Care Unit, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Ronit
authors.initials: R
authors.lastname: Leiba
authors.affiliation: Department of Medicine, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Moshe
authors.initials: M
authors.lastname: Mittelman
authors.affiliation: Division of Hematology, Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Drorit
authors.initials: D
authors.lastname: Merkel
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects; D001374:Azacitidine / Q000008:administration & dosage* / Q000009:adverse effects; D001424:Bacterial Infections / Q000209:etiology*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000188:drug therapy*; D008297:Male; D009181:Mycoses / Q000209:etiology; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000188:drug therapy*; D010976:Platelet Count; D012307:Risk Factors; D014777:Virus Diseases / Q000209:etiology*
chemical_list: D000964:Antimetabolites, Antineoplastic; D001374:Azacitidine
keywords: Azacitidine; Cytogenetics; Dose adjustment; Infection; Myelodysplastic syndrome