AML-197 Incidence of Infectious Lung Disease in Neutropenic Patients

Abstract

Immunosuppression caused by hematologic malignancies can affect all cell lines, but profound neutropenia is the main risk factor. The most common infection is pneumonia. More than 60% of neutropenic patients develop a lung infection. These infections develop in 13-31% of patients during induction chemotherapy for acute myeloid leukemia (AML). They are associated with a significantly higher mortality rate than other infectious diseases. Deduce the incidence of infectious lung disease in our neutropenic patients. This is an observational, descriptive, and prospective study carried out in the Department of Hematology and Pediatric Oncology 20 August of Casablanca, spread over a period of 10 months, from 01 May 2019 to 29 February 2020. It focuses on adult patients over 18 years of age with neutropenia (a PNN count < 2×109/L) hospitalized in the protected unit (AML and aplastic anemia) and the transplant unit, who presented an episode of infectious lung disease during the study period. We determined the incidence and studied the clinical and radiological presentation, the diagnostic steps to obtain biological and microbiological documentation, and the final evolution of these infectious episodes. Out of a total of 235 admissions, 50 episodes of infectious lung disease were identified in 49 patients, for an overall incidence of 21.28%. The most frequent phase of treatment was that of Induction in AML. Thoracic CT was performed in all patients. Bronchoalveolar lavage was performed over 9 episodes. The results were positive in 44.5% of episodes. Serum galactomannan antigenemia assay was performed in 94% of cases, it was positive in 22 (46%). The GeneXpert technique was performed in six episodes (12%), with one positive result. The probable fungal infection was the cause of these infections in 58% of cases. Bacterial pneumopathy was present in 22% of episodes. Pulmonary tuberculosis was diagnosed in only one patient. Pneumocystis was suspected in 4 episodes and viral infection was suspected in 3 episodes. The evolution was favorable in 52% of the cases. The review of the literature has shown that the establishment of an etiological diagnosis is not always possible during these infections, the treatment is essentially empirical, and with a terrible prognosis.