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Supportive Care in Cancer

, Volume 26, Issue 12, pp 4187–4198 | Cite as

Infectious complications in adults undergoing intensive chemotherapy for acute myeloid leukemia in 2001–2005 using the Japan Adult Leukemia Study Group AML201 protocols

  • Hideaki Kato
  • Hiroyuki Fujita
  • Nobu Akiyama
  • 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
  • Yasushi Miyazaki
  • Japan Adult Leukemia Study Group
Original Article

Abstract

Purpose

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.

Methods

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).

Results

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.

Conclusions

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.

Keywords

Acute myeloid leukemia Bacteremia Febrile neutropenia Infectious complication Japan Adult Leukemia Study Group (JALSG) 

Notes

Acknowledgements

This work was supported in part by a grant from the Japan Adult Leukemia Study Group.

Author contributions

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.

Supplementary material

520_2018_4292_MOESM1_ESM.docx (18 kb)
ESM 1 (DOCX 18 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Hideaki Kato
    • 1
  • Hiroyuki Fujita
    • 2
  • Nobu Akiyama
    • 3
  • Shun-ichi Kimura
    • 4
  • Nobuhiro Hiramoto
    • 5
  • Naoko Hosono
    • 6
  • Tsutomu Takahashi
    • 7
  • Kazuyuki Shigeno
    • 8
  • Hitoshi Minamiguchi
    • 9
  • Junichi Miyatake
    • 10
  • Hiroshi Handa
    • 11
  • Yoshinobu Kanda
    • 4
    • 12
  • Minoru Yoshida
    • 13
  • Shuichi Miyawaki
    • 14
  • Shigeki Ohtake
    • 15
  • Tomoki Naoe
    • 16
  • Hitoshi Kiyoi
    • 17
  • Itaru Matsumura
    • 18
  • Yasushi Miyazaki
    • 19
  • Japan Adult Leukemia Study Group
  1. 1.Department of Hematology and Clinical ImmunologyYokohama City University Graduate School of MedicineYokohamaJapan
  2. 2.Department of HematologySaiseikai Yokohama Nanbu HospitalYokohamaJapan
  3. 3.Department of Internal MedicineTeikyo University School of MedicineTokyoJapan
  4. 4.Division of Hematology, Saitama Medical CenterJichi Medical UniversityShimotsukeJapan
  5. 5.Department of HematologyKobe City Medical Center General HospitalKobeJapan
  6. 6.Department of Hematology and OncologyUniversity of FukuiFukuiJapan
  7. 7.Department of Oncology/HematologyShimane University HospitalIzumoJapan
  8. 8.Department of Hematology, Hamamatsu Medical CenterHamamatsuJapan
  9. 9.Department of Gastroenterology and HematologyShiga University of Medical ScienceOtsuJapan
  10. 10.Department of HematologySakai Hospital Kinki University Faculty of MedicineSakaiJapan
  11. 11.Department of HematologyGunma University Graduate School of MedicineMaebashiJapan
  12. 12.Division of Hematology, Department of MedicineJichi Medical UniversityShimotsukeJapan
  13. 13.Fourth Department of Internal Medicine, Mizonokuchi HospitalTeikyo University School of MedicineTokyoJapan
  14. 14.Department of TransfusionTokyo Metropolitan Ohtsuka HospitalTokyoJapan
  15. 15.Kanazawa UniversityKanazawaJapan
  16. 16.National Hospital Organization Nagoya Medical CenterNagoyaJapan
  17. 17.Department of Hematology and OncologyNagoya University Graduate School of MedicineNagoyaJapan
  18. 18.Department of Hematology and RheumatologyKindai University Faculty of MedicineHigashiosakaJapan
  19. 19.Department of Hematology and Molecular Medicine Unit, Atomic Bomb Disease InstituteNagasaki University Graduate School of Biomedical SciencesNagasakiJapan

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