Infectious complications in adults undergoing intensive chemotherapy for acute myeloid leukemia in 2001–2005 using the Japan Adult Leukemia Study Group AML201 protocols
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The Japan Adult Leukemia Study Group (JALSG) AML201 protocols are regimens for remission induction and consolidation chemotherapy of acute myeloid leukemia (AML) and have been widely accepted in Japan since 2001. Management of infectious complications during chemotherapy has a key role in the supportive care of AML patients.
By using case report forms collected in December 2001 and December 2005, we retrospectively analyzed the infectious complications in adult patients treated by using the JALSG AML201 protocols against AML (excluding promyelocytic leukemia).
Of 980 patients, 80.2% experienced febrile neutropenia (FN), 8.3% bacteremia/fungemia, and 10.3% pulmonary infection at least once during remission-induction chemotherapy. Gram-positive bacteremia accounted for 65.1% of bacteremia/fungemia in 2001–2005, compared with 38.2% in 1987–1991 and 45.9% in 1992–1995. Of 750 patients, 81.9% experienced FN, 21.9% bacteremia/fungemia, and 9.1% pulmonary infection at least once during consolidation chemotherapy. During consolidation chemotherapy, bacteremia/fungemia and pulmonary infection were significantly more frequent in the high-dose cytarabine (HDAC) arm than in the conventional multiagent arm (25.9 vs. 17.9% and 12.7 vs. 7.7%, respectively). Invasive pulmonary aspergillosis accounted for 15.8% of pulmonary infections during remission induction and 19.7% during consolidation chemotherapy.
Our data suggest that patterns of infectious complications have changed between 1987 and 2005, possibly because of chemoprophylaxis with oral fluoroquinolones and improved diagnosis of invasive pulmonary aspergillosis by serum antigen analysis.
KeywordsAcute myeloid leukemia Bacteremia Febrile neutropenia Infectious complication Japan Adult Leukemia Study Group (JALSG)
This work was supported in part by a grant from the Japan Adult Leukemia Study Group.
Hideaki Kato: research design and performance, data collection and interpretation, and manuscript writing. Hiroyuki Fujita: research organization and supervision. Nobu Akiyama: data analysis. Shun-ichi Kimura, Nobuhiro Hiramoto, Naoko Hosono, Tsutomu Takahashi, Kazuyuki Shigeno, Hitoshi Minamiguchi, Junichi Miyatake, Hiroshi Handa, Yoshinobu Kanda, Minoru Yoshida, Shuichi Miyawaki, Shigeki Ohtake, Tomoki Naoe, Hitoshi Kiyoi, Itaru Matsumura, and Japan Adult Leukemia Study Group: research performance. Yasushi Miyazaki: research supervision. For a complete list of the members of the JALSG, see the supplemental Appendix.
Compliance with ethical standards
Conflicts of interest
Hideaki Kato received grants from Japan Blood Products Organization and Shionogi. Hiroyuki Fujita received honoraria from Novartis, and payment for manuscripts from Chugai Pharmaceutical. Shun-ichi Kimura received honoraria from Pfizer, Astellas, Sumitomo Dainippon Pharma, and Nippon Kayaku. Tsutomu Takahashi received grants from Chugai Pharmaceutical, Kyowa Hakko Kirin, and Astellas, honoraria from Chugai Pharmaceutical, Kyowa Hakko Kirin, Taiho Pharmaceutical and Celgene Corporation. Junichi Miyatake received honoraria from Kyowa Hakko Kirin, Celgene Corporation, Sumitomo Dainippon Pharma, Takeda Pharmaceutical, and Chugai Pharmaceutical. Hiroshi Handa received consulting fee from Takeda Pharmaceutical and Celgene Corporation, grants and honoraria from Celgene Corporation, Takeda Pharmaceutical, Pfizer, Astellas, Sanofi, MSD, Shionogi, Daiichi Sankyo, Kyowa Hakko Kirin, Novartis, and Shire. Shunichi Miyawaki received a consulting fee from Astellas and expert testimony from Ohtsuka Pharmaceutical and Novartis. Hitoshi Kiyoi received consulting fees from Astellas and Daiichi Sankyo, grants from Chugai Pharmaceutical, Bristol-Myers Squibb, Kyowa Hakko Kirin, Zenyaku Kogyo, FUJIFILM Corporation, Nippon Boehringer Ingelheim, Astellas and Celgene Corporation, and honoraria from Bristol-Myers Squibb and Pfizer. Other authors: none to declare.
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