Abstract
Infectious complications during induction chemotherapy of acute myeloid leukaemia are very common. Prophylactic use of antibiotics however is an ongoing challenge in this situation due to bacterial multi-drug resistance. The aim of this study was to provide a comprehensive overview of the incidence of infectious complications in patients with AML undergoing induction therapy using the "7+3" protocol without routine antibiotic prophylaxis at one clinical site providing specialised haematological care in the Czech Republic, over a period of 15 years. The study also evaluates the aetiological spectrum of causative agents and the development of antibiotic resistance in the context of the use of the various classes of antibiotics. The analysis includes evaluation of the importance of risk factors for infectious complications and their impact on treatment of the underlying disease. The data are compared with published figures for similar cohorts of patients. This study presents a retrospective analysis of infectious complications in 242 patients with acute myeloid leukaemia undergoing the first cycle of induction therapy without routine antibiotic prophylaxis in one clinical site in Czech Republic during years 2006-2020. A total of 363 febrile episodes (FE) were recorded. At least 1 FE during the induction was detected in 229 (94.6%) patients. Clinically defined infection was the cause in 96 (26.4%) FEs and blood stream infection in 69 (19.0%) FEs. Both complications occurred simultaneously in 29 (8.0%) FEs. 169 (46.6%) FEs were evaluated as fever of unknown origin (FUO). The achievement of complete remission had a significant effect on the duration of the FE (6 vs. 9 days, P=0.0005) and on the overall survival duration (79.3 vs. 6.5 months, P<0.0001). Patients diagnosed with infection or FUO at diagnosis were significantly more likely to suffer from colonisation by multi-drug resistant bacterial strains at discharge (29.2% vs. 16.3%, P=0.022). This group of patients used antibiotic therapy for a significantly longer time (35 vs. 23 days, P<0.0001). Infection was a contributing cause of death in 18 (7.4%) patients. Mortality was significantly related to the failure to achieve complete remission (P<0.0001). Infectious mortality during induction treatment without routine antibiotic prophylaxis was comparable to the published cohorts with prophylaxis. Regular microbiology surveillance with adequate initial antibiotic treatment can compensate routine antibiotic prophylaxis with slower development of antibiotic resistance.
Highlights
Acute myeloid leukaemias (AML) constitute a heterogeneous group of haematopoietic malignant disorders
A total of 51 (21.1%) cases were classified as secondary AML: 30 (58.8%) patients had a history of myelodysplastic syndrome (MDS) and 21 (41.2%) had undergone anticancer therapy for other haematological malignancies or solid tumours
141 (58.3%) patients underwent induction chemotherapy in the “7 + 3” protocol with daunorubicin and 90 (37.2%) patients, with mitoxantrone. 11 (4,5%) patients received induction therapy “7 + 3” in a different composition based on other anthracyclines, FLT3 inhibitors and/or gemtuzumab ozogamicin
Summary
Acute myeloid leukaemias (AML) constitute a heterogeneous group of haematopoietic malignant disorders. Despite the advances in supportive care, induction chemotherapy remains one of the most high-risk phases of AML therapy, with mortality at the level of 5% in developed countries, but up to 15–25% in developing countries This is caused by the high incidence of infections by multi-drug resistant bacteria due to the unregulated use of antibiotics[5-9]. The aim of this study was to provide a comprehensive overview of the incidence of infectious complications in patients with AML undergoing induction therapy using the “7+3” protocol without routine antibiotic prophylaxis at one clinical site providing specialised haematological care in the Czech Republic, over a period of 15 years. This study presents a retrospective analysis of infectious complications in 242 patients with acute myeloid leukaemia undergoing the first cycle of induction therapy without routine antibiotic prophylaxis in one clinical site in Czech Republic during years 2006–2020. Regular microbiology surveillance with adequate initial antibiotic treatment can compensate routine antibiotic prophylaxis with slower development of antibiotic resistance
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Schedule a callMore From: Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia
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