Krzysztof Mądry1, Karol Lis2, Przemysław Biecek3, Magda Młynarczyk3, Jagoda Rytel1, Michał Górka1, Piotr Kacprzyk1, Magdalena Dutka4, Marek Rodzaj5, Łukasz Bołkun6, Dorota Krochmalczyk7, Ewa Łątka7, Joanna Drozd-Sokołowska1, Anna Waszczuk-Gajda1, Wanda Knopińska-Posłuszny8, Anna Kopińska9, Edyta Subocz10, Anna Masternak11, Renata Guzicka-Kazimierczak12, Lidia Gil13, Rafał Machowicz1, Jarosław Biliński1, Sebastian Giebel14, Tomasz Czerw14, Jadwiga Dwilewicz-Trojaczek1. 1. Department of Hematology, Oncology and Internal Diseases, Medical University, Warsaw, Poland. 2. Department of Hematology, Oncology and Internal Diseases, Medical University, Warsaw, Poland. Electronic address: k.lis@linux.pl. 3. Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland. 4. Department of Hematology and Bone Marrow Transplantation, Medical University, Gdańsk, Poland. 5. Department of Hematology, Voivodal Specialistic Hospital, Kraków, Poland. 6. Department of Hematology, Medical University, Białystok, Poland. 7. Department of Hematology, Jagiellonian University, Kraków, Poland. 8. Department of Hematology, SP ZOZ WMCO Oncology Center, Olsztyn, Poland. 9. Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, Katowice, Poland. 10. Department of Hematology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland. 11. Department of Hematology, Specialist Hospital, Opole, Poland. 12. Department of Hematology, Pomeranian Medical University, Szczecin, Poland. 13. Department of Hematology, Medical University, Poznań, Poland. 14. Department of Bone Marrow Transplantation and Hematology-Oncology, Cancer Center and Institute of Oncology, Gliwice, Poland.
Abstract
BACKGROUND: Myelodysplastic syndromes (MDS), chronic myelomonocytic leukemia (CMML), and acute myeloid leukemia (AML) patients, including those treated with azacitidine, are at increased risk for serious infections. The aim of our study was to identify patients with higher infectious risk at the beginning of azacitidine treatment. PATIENTS AND METHODS: We performed a retrospective evaluation of 298 MDS/CMML/AML patients and included in the analysis 232 patients who completed the first 3 cycles of azacitidine therapy or developed Grade III/IV infection before completing the third cycle. RESULTS: Overall, 143 patients (62%) experienced serious infection, and in 94 patients (41%) infection occurred within the first 3 cycles. The following variables were found to have the most significant effect on the infectious risk in multivariate analysis: red blood cell transfusion dependency (odds ratio [OR], 2.38; 97.5% confidence interval [CI], 1.21-4.79), neutropenia <0.8 × 109/L (OR, 3.03; 97.5% CI, 1.66-5.55), platelet count <50 × 109/L (OR, 2.63; 97.5% CI, 1.42-4.76), albumin level <35 g/dL (OR, 2.04; 97.5% CI, 1.01-4.16), and Eastern Cooperative Oncology Group performance status ≥2 (OR, 2.19; 97.5% CI, 1.40-3.54). Each of these variables is assigned 1 point, and the combined score represents the proposed Azacitidine Infection Risk Model. The infection rate in the first 3 cycles of therapy in lower-risk (0-2 score) and higher-risk (3-5 score) patients was 25% and 73%, respectively. The overall survival was significantly reduced in higher-risk patients compared with the lower-risk cohort (8 vs. 29 months). CONCLUSION: We selected a subset with high early risk for serious infection and worse clinical outcome among patients treated with azacitidine.
BACKGROUND:Myelodysplastic syndromes (MDS), chronic myelomonocytic leukemia (CMML), and acute myeloid leukemia (AML) patients, including those treated with azacitidine, are at increased risk for serious infections. The aim of our study was to identify patients with higher infectious risk at the beginning of azacitidine treatment. PATIENTS AND METHODS: We performed a retrospective evaluation of 298 MDS/CMML/AMLpatients and included in the analysis 232 patients who completed the first 3 cycles of azacitidine therapy or developed Grade III/IV infection before completing the third cycle. RESULTS: Overall, 143 patients (62%) experienced serious infection, and in 94 patients (41%) infection occurred within the first 3 cycles. The following variables were found to have the most significant effect on the infectious risk in multivariate analysis: red blood cell transfusion dependency (odds ratio [OR], 2.38; 97.5% confidence interval [CI], 1.21-4.79), neutropenia <0.8 × 109/L (OR, 3.03; 97.5% CI, 1.66-5.55), platelet count <50 × 109/L (OR, 2.63; 97.5% CI, 1.42-4.76), albumin level <35 g/dL (OR, 2.04; 97.5% CI, 1.01-4.16), and Eastern Cooperative Oncology Group performance status ≥2 (OR, 2.19; 97.5% CI, 1.40-3.54). Each of these variables is assigned 1 point, and the combined score represents the proposed AzacitidineInfection Risk Model. The infection rate in the first 3 cycles of therapy in lower-risk (0-2 score) and higher-risk (3-5 score) patients was 25% and 73%, respectively. The overall survival was significantly reduced in higher-risk patients compared with the lower-risk cohort (8 vs. 29 months). CONCLUSION: We selected a subset with high early risk for serious infection and worse clinical outcome among patients treated with azacitidine.
Authors: Johanne Rozema; Mels Hoogendoorn; Iris Potma; Inge Ten Seldam; Nic J G M Veeger; Robby E Kibbelaar; Arjan A van de Loosdrecht; Eric N van Roon Journal: EJHaem Date: 2022-03-25