title: Infections in patients with acute myeloid leukemia treated with low-intensity therapeutic regimens: Risk factors and efficacy of antibiotic prophylaxis.
abstract: Survival of acute myeloid leukemia (AML) patients, who are unfit for high-dose chemotherapy, has significantly improved with the advent of low-intensity therapeutic regimens (LITR, comprising decitabine, azacitidine, and low-dose cytarabine). However, infectious complications are common during LITR treatment and might hamper the beneficial effect of these drugs. In this study, we aimed to evaluate the incidence of and predisposing risk factors for infections during LITR treatment of AML, as well as the value of antibiotic prophylaxis within this setting. Therefore, we retrospectively analyzed 40 AML patients, treated with 215 cycles of LITR and analyzed putative risk factors by multivariate logistic regression. Infections occurred in 53/215 (25%) of LITR cycles, resulting in death in six patients. Of the parameters assessed at the start of each LITR cycle, transfusion dependence (p=0.008) and increased LDH (p=0.027) independently predicted the occurrence of infection. Most importantly, however, antibiotic prophylaxis was independently associated with a decreased rate of infectious complications (p=0.030). It was regularly performed in neutropenic patients and even managed to eliminate low neutrophil counts as risk factor in multivariate models. These data argue for the efficacy of antibiotic prophylaxis during LITR therapy of AML and suggest its further evaluation within a prospective clinical trial.
authors: Division of Hematology, Medical University of Graz, Auenbruggerplatz 38, A-8036 Graz, Austria.
authors: Antonia
authors: A
authors: Bainschab
authors: Institute of Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2, A-8036 Graz, Austria.
authors: Franz
authors: F
authors: Quehenberger
authors: Division of Hematology, Medical University of Graz, Auenbruggerplatz 38, A-8036 Graz, Austria.
authors: Hildegard T
authors: HT
authors: Greinix
authors: Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria.
authors: Robert
authors: R
authors: Krause
authors: Division of Hematology, Medical University of Graz, Auenbruggerplatz 38, A-8036 Graz, Austria.
authors: Albert
authors: A
authors: Wölfler
authors: Division of Hematology, Medical University of Graz, Auenbruggerplatz 38, A-8036 Graz, Austria.
authors: Heinz
authors: H
authors: Sill
authors: Division of Hematology, Medical University of Graz, Auenbruggerplatz 38, A-8036 Graz, Austria. Electronic address: armin.zebisch@medunigraz.at.
authors: Armin
authors: A
authors: Zebisch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis / Q000379:methods*; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D001374:Azacitidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control*; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D000077209:Decitabine; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014777:Virus Diseases / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine; D000077209:Decitabine; D001374:Azacitidine
keywords: Acute myeloid leukemia; Antibiotic prophylaxis; Infection; Low-intensity treatment regimen