title: Incidence, etiology and timing of infections following azacitidine therapy for myelodysplastic syndromes.
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.
authors.affiliation: a Department of Infectious Diseases , Peter MacCallum Cancer Centre , East Melbourne , Australia.|b Department of Medicine , University of Melbourne , Melbourne , Australia.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Trubiano
authors.affiliation: c Department of Haematology , Peter MacCallum Cancer Centre , East Melbourne , Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Dickinson
authors.affiliation: 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.
authors.forename: Karin A
authors.initials: KA
authors.lastname: Thursky
authors.affiliation: b Department of Medicine , University of Melbourne , Melbourne , Australia.
authors.forename: Timothy
authors.initials: T
authors.lastname: Spelman
authors.affiliation: b Department of Medicine , University of Melbourne , Melbourne , Australia.|c Department of Haematology , Peter MacCallum Cancer Centre , East Melbourne , Australia.
authors.forename: John F
authors.initials: JF
authors.lastname: Seymour
authors.affiliation: 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.
authors.forename: Monica A
authors.initials: MA
authors.lastname: Slavin
authors.affiliation: a Department of Infectious Diseases , Peter MacCallum Cancer Centre , East Melbourne , Australia.|b Department of Medicine , University of Melbourne , Melbourne , Australia.
authors.forename: Leon J
authors.initials: LJ
authors.lastname: Worth
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects; D001374:Azacitidine / Q000009:adverse effects; D001424:Bacterial Infections / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy; D009190:Myelodysplastic Syndromes / Q000188:drug therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000964:Antimetabolites, Antineoplastic; D001374:Azacitidine
keywords: Azacitidine; complications; infection; invasive fungal disease; myelodysplastic syndrome