Hideaki Kato1, Hiroyuki Fujita2, Nobu Akiyama3, Shun-Ichi Kimura4, Nobuhiro Hiramoto5, Naoko Hosono6, Tsutomu Takahashi7, Kazuyuki Shigeno8, Hitoshi Minamiguchi9, Junichi Miyatake10, Hiroshi Handa11, Yoshinobu Kanda4,12, Minoru Yoshida13, Shuichi Miyawaki14, Shigeki Ohtake15, Tomoki Naoe16, Hitoshi Kiyoi17, Itaru Matsumura18, Yasushi Miyazaki19. 1. Department of Hematology and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan. 2. Department of Hematology, Saiseikai Yokohama Nanbu Hospital, Yokohama, Japan. fujitah@nanbu.saiseikai.or.jp. 3. Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan. 4. Division of Hematology, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan. 5. Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan. 6. Department of Hematology and Oncology, University of Fukui, Fukui, Japan. 7. Department of Oncology/Hematology, Shimane University Hospital, Izumo, Japan. 8. Department of Hematology, Hamamatsu Medical Center, Hamamatsu, Japan. 9. Department of Gastroenterology and Hematology, Shiga University of Medical Science, Otsu, Japan. 10. Department of Hematology, Sakai Hospital Kinki University Faculty of Medicine, Sakai, Japan. 11. Department of Hematology, Gunma University Graduate School of Medicine, Maebashi, Japan. 12. Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan. 13. Fourth Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine, Tokyo, Japan. 14. Department of Transfusion, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan. 15. Kanazawa University, Kanazawa, Japan. 16. National Hospital Organization Nagoya Medical Center, Nagoya, Japan. 17. Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan. 18. Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, Higashiosaka, Japan. 19. Department of Hematology and Molecular Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
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.
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 AMLpatients. 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.
Entities:
Keywords:
Acute myeloid leukemia; Bacteremia; Febrile neutropenia; Infectious complication; Japan Adult Leukemia Study Group (JALSG)
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