Abstract
Background Infections are an important cause of morbidity and mortality for acute lymphoblastic leukemia (ALL). However, the reports regarding risk factors of induction-related infection are roughly unknown/limited in adult T-ALL during induction chemotherapy. Methods We performed a retrospective cohort study for the prevalence and risk predictors of induction-related infection among consecutive T-ALL patients (N = 97) enrolled in a PDT-ALL-LBL clinical trial. Of 97 patients with T-ALL enrolled in the trial, 46 were early T-cell precursor (ETP) ALL and 51 were non-ETP ALL. Results When compared with non-ETP, ETP ALL subtype was characterized with lower neutrophil count (1.35 × 109/L vs. 8.7 × 109/L, P < 0.001) and lower myeloid percentage in the bone marrow (13.35% vs. 35.31%, P = 0.007). Additionally, ETP ALL had longer neutropenia before diagnosis (P < 0.001), as well as during induction chemotherapy (P < 0.001). Notably, the ETP cohort experienced higher cumulative incidence of clinically documented infections (CDI; 33.33%, P = 0.001), microbiologically documented infections (MDI; 45.24%, P = 0.006), resistant infection (11.9%, P = 0.013), and mixed infection (21.43%, P = 0.003), respectively, than those of the non-ETP cohort. Furthermore, multivariable analysis revealed that T-ALL mixed infection was more likely related to chemotherapy response (OR, 0.025; 95% CI 0.127-0.64; P = 0.012) and identified myeloid percentage as a predictor associated with ETP-ALL mixed infection (OR, 0.915; 95% CI 0.843-0.993; P = 0.033), with ROC-defined cut-off value of 2.24% in ETP cohorts. Conclusions Our data for the first time demonstrated that ETP-ALL characterized with impaired myelopoiesis were more susceptible to induction-related infection among T-ALL populations.
Highlights
Infections are important causes on morbidity and mortality of children and adults with acute leukemia [1,2,3,4,5,6,7]
A total of 97 patients received intensive induction chemotherapy according to the PDT-acute lymphoblastic leukemia (ALL)-LBL protocol and experienced 92 episodes of infections within first 24 days of induction phase (Figure 1)
It has been documented that intensive induction chemotherapy yielded serious neutropenia and high incidence of infection in ALL, but little has been reported about risk factors implicated in T-ALL population. [9, 19, 22] Our study revealed that early T-cell precursor (ETP) ALL was characterized with markedly impaired myelopoiesis at diagnosis, presenting with lower neutrophil and reduced myeloid percentage, when compared with non-ETP ALL
Summary
Infections are important causes on morbidity and mortality of children and adults with acute leukemia [1,2,3,4,5,6,7] These patients are at a high risk of infection, in induction therapy, likely related to the intensive therapy resulting in profound neutropenia and lymphopenia. ETP-ALL is characterized with a unique immunophenotype of early arrest in T-cell differentiation, accompanied by markers of stem cells and myeloid progenitors [11,12,13,14,15,16,17] It is less documented about the epidemiology and risk factors of invasive infection in adult ALL, in ETP-ALL, undergoing induction chemotherapy. Our data for the first time demonstrated that ETP-ALL characterized with impaired myelopoiesis were more susceptible to induction-related infection among T-ALL populations
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