Comparison of neutropenia profiles in different treatment protocols for acute myeloid leukemia using the D-index

Abstract

Neutropenia is a major risk factor for opportunistic infections in patients with acute myeloid leukemia (AML) who undergo chemotherapy. In the present study, we retrospectively compared the D-index, which reflects both the depth and duration of neutropenia, between two different chemotherapy regimens for AML. Sixty-seven patients with AML were included: 37 received an induction regimen of daunorubicin (DNR) and cytarabine followed by consolidation therapies consisting of standard-dose cytarabine (SDAC) and other antineoplastic agents; the remaining 30 received idarubicin (IDR) and cytarabine as remission induction therapy followed by high-dose cytarabine (HDAC). The duration of neutropenia was shorter, but the D-index was higher, with IDR than with DNR. The total D-index during the entire consolidation therapies was significantly higher with SDAC than with HDAC. In conclusion, the neutropenia profile differs between treatment regimens, and thus, physicians should plan the management of infectious complications according to the neutropenia profile for each regimen.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52:e56–93.

    Article  PubMed  Google Scholar 

  2. 2.

    Klastersky J. Management of fever in neutropenic patients with different risks of complications. Clin Infect Dis. 2004;39(Suppl 1):32–7.

    Article  Google Scholar 

  3. 3.

    Portugal RD, Garnica M, Nucci M. Index to predict invasive mold infection in high-risk neutropenic patients based on the area over the neutrophil curve. J Clin Oncol. 2009;27:3849–54.

    Article  PubMed  Google Scholar 

  4. 4.

    Kimura S, Wada H, Ishihara Y, Kawamura K, Sakamoto K, Yamasaki R, et al. D-index dose not predict the development of pulmonary infection in acute myeloid leukemia patients undergoing consolidation chemotherapy with high-dose cytarabine. Hematology. 2014;19:107–12.

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Kimura S, Oshima K, Sato K, Sato M, Terasako K, Nakasone H, et al. Retrospective evaluation of the area over the neutrophil curve index to predict early infection in hematopoietic stem cell transplantation recipients. Biol Blood Marrow Transplant. 2010;16:1355–61.

    Article  PubMed  Google Scholar 

  6. 6.

    Miyawaki S. Clinical studies of acute myeloid leukemia in the Japan Adult Leukemia Study Group. Int J Hematol. 2012;96:171–7.

    Article  PubMed  Google Scholar 

  7. 7.

    Miyawaki S, Ohtake S, Fujisawa S, Kiyoi H, Shinagawa K, Usui N, et al. A randomized comparison of 4 courses of standard-dose multiagent chemotherapy versus 3 courses of high-dose cytarabine alone in postremission therapy for acute myeloid leukemia in adults: the JALSG AML201 Study. Blood. 2011;117:2366–72.

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Ohtake S, Miyawaki S, Fujita H, Kiyoi H, Shinagawa K, Usui N, et al. Randomized study of induction therapy comparing standard-dose idarubicin with high-dose daunorubicin in adult patients with previously untreated acute myeloid leukemia: the JALSG AML201 Study. Blood. 2011;117:2358–65.

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Sano H, Kobayashi R, Suzuki D, Hori D, Kishimoto K, Kobayashi K. Impact of the D-index deduced from duration and intensity of neutropenia following chemotherapy on the risk of invasive fungal infection in pediatric acute myeloid leukemia. Int J Hematol. 2018;108:85–90.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the patients for their participation in the study.

Author information

Affiliations

Authors

Contributions

YK contributed to the study design, data analysis, and manuscript preparation. SK, HN, KM, YS, SK, YT, SO, TN, DM, RY, KM, MA, CY, KH, KS, IO, SF, KO, SK, KM and YK reviewed the manuscript.

Corresponding author

Correspondence to Yoshinobu Kanda.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kawasaki, Y., Kimura, S., Nakano, H. et al. Comparison of neutropenia profiles in different treatment protocols for acute myeloid leukemia using the D-index. Int J Hematol 109, 470–476 (2019). https://doi.org/10.1007/s12185-019-02593-2

Download citation

Keywords

  • D-index
  • Acute myeloid leukemia
  • Neutropenia
  • Anthracycline
  • High-dose cytarabine