Myeloid Leukemia Undergoing Induction Chemotherapy Research Articles

Psychological Distress in Young Adults with Acute Myeloid Leukemia Undergoing Induction Chemotherapy.

Young adults (YAs), aged 18-39 years, with acute myeloid leukemia (AML) navigate life disruptions amid an unpredictable illness trajectory. We conducted a secondary analysis of patient-reported outcomes for hospitalized YAs with high-risk AML receiving intensive chemotherapy, collected during a multisite randomized clinical trial. Of the 160 patients, 14 (8.8%) were YAs. At week 2 of hospitalization, YAs demonstrated significant worse quality of life (β = -18.27; p = 0.036), higher anxiety (β = 2.72; p = 0.048), and higher post-traumatic stress disorder (PTSD; β = 10.34; p = 0.007) compared with older adults. Our analysis demonstrated a longitudinal presence of anxiety and PTSD, suggesting persistent unmet psychological needs for YAs with AML.

Tailoring a physical activity intervention to older adults receiving intensive chemotherapy for acute myeloid leukemia (AML): One size does not fit all

Older adults are at risk for functional decline during acute myeloid leukemia (AML) therapy [ [1] Klepin H.D. Tooze J.A. Pardee T.S. et al. Effect of intensive chemotherapy on physical, cognitive, and emotional health of older adults with acute myeloid leukemia. J Am Geriatr Soc. 2016; 64: 1988-1995 Crossref PubMed Scopus (55) Google Scholar ]. While some survivors demonstrate resilience [ [2] Mohamedali H. Breunis H. Timilshina N. et al. Older age is associated with similar quality of life and physical function compared to younger age during intensive chemotherapy for acute myeloid leukemia. Leuk Res. 2012; 36: 1241-1248 Crossref PubMed Scopus (38) Google Scholar , [3] Timilshina N. Breunis H. Tomlinson G.A. et al. Long-term recovery of quality of life and physical function over three years in adult survivors of acute myeloid leukemia after intensive chemotherapy. Leukemia. 2019; 33: 15-25 Crossref Scopus (13) Google Scholar ], short-term declines in physical function can be dramatic during an induction hospitalization [ [1] Klepin H.D. Tooze J.A. Pardee T.S. et al. Effect of intensive chemotherapy on physical, cognitive, and emotional health of older adults with acute myeloid leukemia. J Am Geriatr Soc. 2016; 64: 1988-1995 Crossref PubMed Scopus (55) Google Scholar ]. Physical performance (measured by the Short Physical Performance Battery [SPPB]) is predictive of survival at the time of diagnosis [ [4] Klepin H.D. Geiger A.M. Tooze J.A. et al. Geriatric assessment predicts survival for older adults receiving induction chemotherapy for acute myelogenous leukemia. Blood. 2013; 121: 4287-4294 Crossref PubMed Scopus (254) Google Scholar ], declines during induction therapy [ [1] Klepin H.D. Tooze J.A. Pardee T.S. et al. Effect of intensive chemotherapy on physical, cognitive, and emotional health of older adults with acute myeloid leukemia. J Am Geriatr Soc. 2016; 64: 1988-1995 Crossref PubMed Scopus (55) Google Scholar ], and is associated with shorter survival when measured at the time of remission [ [5] Saad M. Loh K.P. Tooze J.A. et al. Geriatric assessment and survival among older adults receiving post-remission therapy for acute myeloid leukemia. Blood. 2020; 136: 2715-2719 Crossref PubMed Google Scholar ]. Interventions designed to maintain physical performance may enhance the quality of survivorship, eligibility for subsequent therapies, and could potentially improve survival [ 6 Alibhai S.M. Durbano S. Breunis H. et al. A phase II exercise randomized controlled trial for patients with acute myeloid leukemia undergoing induction chemotherapy. Leuk Res. 2015; (S0145-2126(15)30365-9) Crossref Scopus (39) Google Scholar , 7 Alibhai S.M. O’Neill S. Fisher-Schlombs K. et al. A pilot phase II RCT of a home-based exercise intervention for survivors of AML. Support Care Cancer. 2014; 22: 881-889 Crossref PubMed Scopus (33) Google Scholar , 8 Klepin H.D. Danhauer S.C. Tooze J.A. et al. Exercise for older adult inpatients with acute myelogenous leukemia: a pilot study. J Geriatr Oncol. 2011; 2: 11-17 Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar , 9 Thomas R. Kenfield S.A. Yanagisawa Y. et al. Why exercise has a crucial role in cancer prevention, risk reduction and improved outcomes. Br Med Bull. 2021; 139: 100-119 Crossref Scopus (3) Google Scholar , 10 Ezzatvar Y. Ramírez-Vélez R. Sáez de Asteasu M.L. et al. Physical function and all-cause mortality in older adults diagnosed with cancer: a systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci. 2021; 76: 1447-1453 Crossref Scopus (13) Google Scholar ].

AML-202: A Single-Center Comparative Clinical Study of Prophylactic Antifungal Therapy of Voriconazole versus Posaconazole in Patients with Acute Myeloid Leukemia Undergoing Remission-Induction Therapy

<h3>Context:</h3> Invasive fungal infections are the main cause of morbidity and mortality in patients with acute myeloid leukemia undergoing induction chemotherapy. Prophylaxis is a commonly used treatment strategy because delay in diagnosis and antifungal treatment increases mortality. Posaconazole is currently the preferred drug for fungal prophylaxis, but it is costly and inappropriate in certain resource-limited Indian settings. Both posaconazole and voriconazole have been used as antifungal prophylaxis, but there are very few studies comparing the efficacy of these two drugs. <h3>Objective:</h3> Primary objectives of the study were to identify invasive fungal infections (IFI), evaluate the requirement of EAFT and its duration, and compare them. Secondary objectives were to compare the induction mortalities and adverse effects of the drugs. <h3>Design:</h3> Retrospective observational study. All adult patients (>18 y) with AML undergoing induction chemotherapy in 3 consecutive years (2014–2016) whose complete clinical and treatment details were available were included in the study. <h3>Setting:</h3> The study was carried out at the Institute of Hematology and Transfusion Medicine, Kolkata, which is a tertiary care center for hematological diseases in East India. <h3>Results:</h3> Data for 67 AML patients (31 in voriconazole and 36 in posaconazole) were analyzed. The adoption of voriconazole as antifungal prophylaxis has resulted in a trend toward decreased incidence of breakthrough IFIs (1 <i>vs</i> 3) and the use of EAFT (23.07% <i>vs</i> 38.09%; p=0.067). All proven IFIs were invasive aspergillosis. Induction mortality rate (7 <i>vs</i> 5; p=0.27), and CR rate (80.76% <i>vs</i> 71.42%; p=0.15) are not statistically different. Drug intolerance is higher with voriconazole (9/31 <i>vs</i> 4/36; p=0.05), and 2 patients had premature discontinuation due to significant side effects. <h3>Conclusion:</h3> In our centre, evidence points toward decreased IFI and EAFT in patients with voriconazole prophylaxis as compared to posaconazole, albeit with some increased drug-related adverse effects. In a resource-limited centre, voriconazole may be a useful alternative to posaconazole as a prophylactic antifungal drug in acute myeloid leukemia.

Prospective Study of an Antifungal Program to Reduce Invasive Fungal Infections in Patients with Acute Myeloid Leukemia Receiving Induction and Re-Induction Chemotherapy

Background: Invasive fungal infections (IFI) can occur up to 40% of patients with hematologic malignancies and are most common in patients with acute myeloid leukemia (AML). National averages within the United States, per Infectious Diseases Society of America (IDSA), range approximately from 8-10% in this high risk population. IFIs are not only problematic for individual patient care, potentially resulting in increased antimicrobial usage and delay of future chemotherapy treatments or stem cell transplant, but IFI also negatively impact hospital resource utilization including increased days in hospital and the intensive care unit (ICU).Methods: In attempt to decrease IFIs in hematologic malignancy patients at the University of Virginia Health System (UVAHS), a multidisciplinary team of oncology and infectious diseases physicians, nurses, and pharmacists was formed to develop an Antifungal Program. Retrospective chart review was done of 79 patient encounters from 7/2011 to 9/2014 to establish our baseline cohort. For each of these encounters, extensive patient demographics, clinical, and inpatient event data were collected. Analysis of our baseline data showed a 19.7% proven or probable IFI rate in patients with acute myeloid leukemia undergoing induction chemotherapy. In concordance with IFI rates published by IDSA, we aimed to decrease the IFI in this patient population at UVAHS to less than 10%. With guidance from the American Society of Clinical Oncology's Quality Training Program, our team utilized multiple qualitative and quantitative tools to further understand factors contributing to an increased rate of IFIs. These tools included a process map and Ishikawa cause-and-effect diagram to depict all the steps from leukemia diagnosis to end of treatment and hospital discharge, a Pareto chart to quantify delays of individual steps, and a priority matrix categorizing potential interventions based on impact and ease of implementation. A statistical process control chart (p-chart) depicted rates of IFI in the baseline cohort and intervention groups.Results: Our baseline proven or probable IFI rate in patients with acute myeloid leukemia was 19.7%. Antifungal prophylaxis was not administered to baseline cohort patients. Per Pareto chart analysis, the team identified the most common problems contributing to IFI: inconsistent definition of IFI, no routine antifungal prophylaxis, and lack of education for the health care team. Two Plan-Do-Study-Act (PDSA) cycles of interventions were implemented; post-intervention data were collected and analyzed. From 9/2014 to 8/2016, the first PDSA cycle consisted of individual attending physicians ordering antifungal prophylaxis on an ad hoc basis; the first PDSA cycle resulted in a decreased IFI rate of 11.7% (n = 77). Though close to project aim of less than 10%, this process was burdensome and not sustainable, as it required individual physicians to remember to add antifungal prophylaxis and did not standardize which antifungal agent was used. During the second PDSA cycle from 8/2016 to 4/2017, a clinical practice guideline standardized the definition of IFI and recommended posaconazole as the prophylactic antifungal of choice. Team champions educated physicians, nurses, and pharmacists on the new standard work. This second PDSA cycle resulted in zero IFIs (n = 18), surpassing the team's goal of improving IFI to less than 10%. P-chart depicting IFI reduction is shown in Figure 1. Additionally, median ICU length of stay improved from 2.5 days to 1.5 days. Overall hospital length of stay decreased from 32.3 days to 29.9 days. As no proven or probable IFI were diagnosed during PDSA Cycle 2, no resistant fungal organisms were noted.Conclusions: This project illustrates the importance of forming a multidisciplinary team, whose collaborative effort developed an Antifungal Program that reduced IFI rates in a statistical significant method. When compared to historical controls, the Antifungal Program decreased both IFI rates and ICU length of stay. To ensure sustainability of the quality improvement study, monthly electronic medical record reports will capture guideline compliance, specifically the use of antifungal agents, and track future IFI. The Antifungal Program is an effective clinical tool to not only improve patient care, but likely represents increased patient quality of life, cost-savings, and decreased length of stay. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Psychological Distress in Young Adults with Acute Myeloid Leukemia Undergoing Induction Chemotherapy

Introduction: Young adults (YAs), ages 18-39 years diagnosed with cancer have distinct physical, developmental, and psychosocial needs that are often unmet during oncologic treatment. In acute myeloid leukemia (AML), a disease affecting both younger and older adults, patients navigate several treatment intensity choices, and with intensive induction chemotherapy are often balancing a chance of cure with a risk of death. Furthermore, YAs with AML can have marked life disruptions with this unpredictable illness trajectory and prolonged induction hospitalization, further conflicting with normal development at this stage. Fundamentally different than solid tumors, we lack an understanding of the YA experience in AML induction compared to their older counterparts. This study explores patient-reported outcomes (PROs) including quality of life (QOL) and physical and psychological symptom burden among YAs undergoing induction chemotherapy. Methods: We conducted a secondary analysis of 160 patients with high-risk AML hospitalized to receive intensive chemotherapy who were enrolled in a randomized control trial of palliative care (PC) intervention versus standard oncology care. Patients with newly diagnosed, relapsed, or refractory AML receiving intensive treatment requiring a 4-6 week hospitalization were enrolled in the study. We used the Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu), the Edmonton Symptom Assessment System (ESAS), the Hospital Anxiety and Depression Scale (HADS), and the Post-Traumatic Stress Disorder (PTSD) Checklist to assess QOL, symptom burden, and psychological distress respectively. Assessments were administered at baseline, week-2, and week-4 following initiation of chemotherapy. We used descriptive statistics to compare PROs at baseline between YAs (&amp;lt; 40 years) and older adults. We used linear regression models controlling for PC intervention effect when examining the association between age (YAs versus older adults) and PROs at week-2. We used linear mixed effect models controlling for randomization to the PC intervention to assess the association between age and PROs longitudinally throughout the hospitalization. Results: Of the 160 patients with high-risk AML enrolled in this study, 14 (8.8%) were YAs &amp;lt; 40 years. Demographic characteristics highlight that the majority of YAs had relapsed AML (n=10, 71.4%) and there was a greater presence of racial and ethnic diversity compared to older adults. The baseline mean QOL score for YAs was 110.5 (SD 34.2). Overall, 57.1% (8/14) reported clinically significant anxiety and 50% (7/14) reported clinically significant PTSD symptoms at baseline. Fewer YA patients, 21.4% (3/14) reported clinically significant depression. Evaluation of PROs at week-2 nadir adjusted for randomization to the PC intervention, highlighted a significant lower QOL (β=-18.27; p=0.036), higher anxiety (β=2.72; p=0.048), and higher PTSD symptoms (β=10.34; p=0.007) for YAs compared to older adults. Longitudinal analyses exploring the impact of age on PROs across induction hospitalization demonstrated that YAs had consistently significant higher anxiety (β=3.66; p=0.024) and PTSD symptoms (β=15.64; p&amp;lt;0.001) compared to older adults [Figure 1]. Conclusions: For YAs with AML undergoing induction chemotherapy, anxiety and PTSD symptoms are highly prevalent both at baseline and longitudinally throughout the induction hospitalization. This demonstrates a continued unmet need of the significant psychological distress and intensified hospitalization experience for YAs compared to their older counterparts. Given that distress during induction hospitalization can be predictive of post-treatment outcomes, it is imperative to tailor integrated supportive care and psychosocial interventions for YAs with AML during induction chemotherapy. Disclosures Walker: Geron: Research Funding; Newave Pharmaceuticals: Research Funding. Bhatnagar:KaryoPharm Therapuetics: Research Funding; Cell Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees; Astellas: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees; KITE: Membership on an entity's Board of Directors or advisory committees.

Practicing Antimicrobial Stewardship: De-Escalating Antibiotics in Patients With Acute Myeloid Leukemia and Neutropenic Fever.

We compared risk of recurrent fever in patients with acute myeloid leukemia undergoing induction chemotherapy with febrile neutropenia without an infectious source in which antibacterials were de-escalated before neutrophil recovery versus continued. There was less recurrent fever when antibacterials were de-escalated early with no increased adverse events.

Dyspnea in Acute Myeloid Leukemia – An Uncommon Presentation of Diffuse Alveolar Hemorrhage

Diffuse alveolar hemorrhage is a life-threatening condition characterized by acute hypoxic respiratory failure, hemoptysis, and acute blood loss anemia. Most common etiologies are related to systemic vasculitis due to ongoing vessel inflammation. Diagnosis, however, can be challenging due to variety of non-specific symptoms. We present a challenging case of a 65-year-old male with newly diagnosed acute myeloid leukemia undergoing induction chemotherapy who developed diffuse alveolar hemorrhage.

Posaconazole for Prophylaxis of Fungal Infection in Pediatric Patients with Acute Myeloid Leukemia undergoing Induction Chemotherapy

Posaconazole for Prophylaxis of Fungal Infection in Pediatric Patients with Acute Myeloid Leukemia undergoing Induction Chemotherapy

Efficacy of Posaconazole Prophylaxis in Patients with Acute Myeloid Leukemia Undergoing Induction Chemotherapy: An Observational Study in Resource Limited Settings.

Large randomized controlled trials have shown significant decrease in incidence of invasive fungal infection in acute myeloid leukemia patients with Posaconazole prophylaxis. However, very less is known about value of Posaconazole prophylaxis in resource limited settings. This observational cohort study evaluated the incidence of fungal infection in patients with hematological malignancies undergoing induction chemotherapy with Posaconazole as antifungal prophylaxis and was compared with historical controls who received Fluconazole as fungal prophylaxis. The study was conducted from Oct 2013 to July 2015 in Department of Hematology of a tertiary care center. Fifty-three patients of acute myeloid leukemia on Posaconazole as fungal prophylaxis and 53 historical controls on Fluconazole as fungal prophylaxis were included for final analysis. Baseline characteristics were well matched between groups. Patients on Fluconazole were more likely to experience breakthrough IFDs (28.3 and 11.3%; p=0.028) than in patients receiving Posaconazole prophylaxis. No significant difference was observed in overall, attributable mortality or in shift to first line antifungal. Both Posaconazole and Fluconazole were well tolerated with no major adverse effects requiring discontinuation of the drug. Minor side effects were seen in 39 and 47% patients in study and control group respectively. Vomiting and nausea were the commonest side effects seen in both study and control group (26 vs. 34% and 38 vs. 40% of patients, respectively). The results of our study in patients with acute myeloid leukemia provide evidence that Posaconazole prophylaxis significantly decreases the incidence of fungal infection and is well tolerated.

Outcomes and changes in code status of patients with acute myeloid leukemia undergoing induction chemotherapy who were transferred to the intensive care unit

Patients with Acute Myeloid Leukemia (AML) have compromised marrow function and chemotherapy causes further suppression. As a result complications are frequent, and patients may require admission to the intensive care unit (ICU). How codes status changes when these events occur and how those changes influence outcome are largely unknown. Outcomes for adult patients with AML, undergoing induction chemotherapy, and transferred to the ICU between January 2000 and December 2013 were analyzed. 94 patients were included. Median survival was 1.3 months. At 3 and 6 months overall survival (OS) was 27% and 18% respectively. Respiratory failure was the most common reason for transfer to ICU (88%), with 63% requiring mechanical ventilation at transfer. Other reasons included: cardiac arrest (18%), septic shock (17%), hypotension (9%), and acute renal failure (9%). The most frequent interventions were mechanical ventilation in 85%, vasopressors in 62%, and hemodialysis in 30%. Following transfer 55 patients (58%) had a change in code status. Overall, 46 patients (49%) changed from Full Code (FC) to Comfort Care (CC), 7 (7%) from FC to Do Not Resuscitate (DNR), and 2 (2%) from DNR to CC. For the entire cohort, ICU mortality (IM) was 61% and hospital mortality (HM) was 71%. For FC or DNR patients, IM was 30% and HM was 41%. For CC patients, IM was 90% and HM was 100%. Overall, 27 patients (29%) survived to discharge. Of those discharged, 22 (81%) were alive at 3 months and 17 (63%) were alive at 6 months. In conclusion, patients that required ICU admission during induction chemotherapy have a poor prognosis. Code status changed during the ICU stay for the majority of patients and always to a less aggressive status.

Quality of Life in Elderly Patients with Acute Myeloid Leukemia Undergoing Induction Chemotherapy

Aims: In elderly patients with acute myeloid leukemia (AML), complete remission (CR) rate following intensive chemotherapy is approximately 45%, considerably lower than in younger patients, with a shorter duration of remission and high treatment-related mortality (30-50%). Median survival is about 12 months. Intensive chemotherapy is indicated in a small proportion of "fit" elderly patients. In a phase III, prospective, randomized, open-label, multicenter trial designed to assess the efficacy of post-remission treatment with 5-Azacitidine versus best supportive care (BSC) in patients > 60 years of age with AML in CR after conventional induction ("3+7") and consolidation chemotherapy, quality of life (QoL) was assessed from diagnosis. We present interim results of changes of QoL.Methods: Patients with newly diagnosed AML with > 30% myeloid marrow blasts, either "de novo" or evolving from myelodysplastic syndrome without contraindications for intensive chemotherapy and with an ECOG performance status < 3 are included. Induction chemotherapy consists of two courses of "3+7": Daunorubicin 40 mg/m2 daily days 1-3 and cytarabine 100 mg/m2 daily continuous IV infusion days 1-7. Patients in CR receive consolidation (cytarabine 800 mg/m2 3 hour infusion bid days 1-3) and are randomized 1:1 to receive BSC or 5-Azacitidine maintenance therapy up to 4 years and six months until AML recurrence. QoL assessment was performed using the EORTC QLQ-C30 and the QOL-E v.3 questionaires.Results: QoL results assessed at 3 time points are reported: 1) baseline; 2) at hematological recovery immediately after the first "3+7" course; and 3) after consolidation at randomization. Ninety-nine patients (male/female 50/49) of median age 70 (IQR 65-74) years have been enrolled. At diagnosis, mean hemoglobin was 9.2 (SD ± 2.4) g/dL, leukocytes were 7.9 (2.3-29.6)/µL, platelet count was 54 (IQR 29-85) Gi/L and bone marrow blasts were 70 (IQR 50-85)%. Seventy-five patients had "de novo" AML. Twenty-three patients had comorbidities. Forty-three patients had an ECOG PS 1 and 28 had ECOG PS 2. Baseline median QOL-E scores were poor (≤60) in all dimensions, except for fatigue (76, IQR 52-85). EORTC QLQ-C30 confirmed that fatigue was not prevalent at diagnosis (median 33, IQR 22-56). Median baseline EORTC QLQ-C30 scores were good in all domains except for global health status (GHS, median 50, IQR 33-67). Gender, comorbidities, bone marrow blasts and secondary AML were not related to QoL. Baseline Hb levels correlated with QOL-E functional (r=0.0216, p=0.14), fatigue (r=0.256, p=0.002) and disease-specific (r=0.247, p=0.010) scores and with EORTC QLQ-C30 GHS (r=0.270, p=0.001), physical (r=0.304, p<0.0001), role (r=0.281, p=0.001), cognitive (r=0.262, p=0.003), social (r=0.229, p=0.010) functions and fatigue (r=-0.280, p=0.001), dyspnea (r=-0.287, p=0.001) and appetite loss (r=0.244, p=0.007). Age correlated with QOL-E disease specific scores (r=0.242, p=0.012). There were no changes in QOL-E scores following 1st "3+7". However, the EORTC QLQ-C30 detected deterioration in physical function from median 80, IQR 60-93, to 67, IQR 52-87 (p=0.008), in role function from median 83, IQR 67-100, to 67, IQR 33-83 (p=0.023) and in GHS from median 50, IQR 33-69, to 67, IQR 50-75 (p=0.002) and improvement in dyspnea (p=0.023). Forty patients obtained a CR. Interestingly, baseline role function was better (median 83, IQR 67-100) in cases obtaining a CR than in resistant patients (median 67, IQR 33-83, p=0.007). Patients obtaining CR experienced improvements after consolidation in median QOL-E physical scores from 56, IQR 41-72 to 63, IQR 50-84 (p=0.033), disease-specific domain scores from 59, IQR 48-67 to 74, IQR 67-85 (p=0.003) and treatment-outcome index scores from 55, IQR 32-77, to 79, IQR 41-86 (p=0.026). Median EORTC QLQ-C30 emotional function improved after consolidation therapy from 83, IQR 67-92, to 92, IQR 77-100 (p=0.015) as well as GHS from median 50, IQR 33-65 to 67, IQR 58-83 (p=0.002). Dyspnea and insomnia regressed while financial problems increased.Conclusions: Elderly patients with AML at diagnosis identified as fit for chemotherapy generally do not present fatigue, though health status is poor and is mainly correlated with Hb levels. Role function may predict response to induction chemotherapy. Patients obtaining CR perceive improvements in global health, including physical and emotional QoL and symptoms. DisclosuresOliva:Celgene: Other: Advisory Board, Speakers Bureau; Amgen: Consultancy; Novartis: Speakers Bureau.

A phase II exercise randomized controlled trial for patients with acute myeloid leukemia undergoing induction chemotherapy

Curative treatment for acute myeloid leukemia (AML) involves induction chemotherapy (IC) which is associated with bed rest and toxicities, leading to worsening quality of life (QOL), fatigue, and fitness. Exercise during IC may ameliorate declines but has not been rigorously tested. We examined the efficacy of supervised exercise during IC on QOL, fatigue, and fitness. Eighty-three inpatients age 18–80 scheduled to receive IC for newly diagnosed or relapsed AML were randomized 2:1 (exercise intervention:control group). Study measures were completed at baseline, post-IC, and following the first cycle of consolidation. The intervention consisted of a supervised mixed-modality, moderate-intensity exercise program (4–5 days per week, 30–60min per session) throughout admission. Recruitment was good (56%), retention excellent (96%), and adherence was 54%. Global QOL improved similarly in both groups from baseline to post-IC (between-group difference 3.0 points, p=0.62). Fatigue improved in the exercise group from baseline to post-IC (potentially clinically important between-group difference of 3.6 points, p=0.23). Aerobic fitness, lower body strength, and grip strength improved in the exercise group (between-group differences p=0.005, p<0.001, p=0.03, respectively). Supervised exercise for patients with AML undergoing IC is feasible, safe, and appears effective at improving fitness and possibly fatigue. A larger trial is warranted.

Comparison of complication rates of Hickman® catheters versus peripherally inserted central catheters in patients with acute myeloid leukemia undergoing induction chemotherapy

Central venous access devices (CVADs) are used for intravenous therapy in patients with hematological malignancies. There are limited data comparing catheter outcomes in patients with acute myeloid leukemia (AML) undergoing induction chemotherapy. A retrospective review comparing the incidence of early and late CVAD-associated complications and their effect on CVAD removal was performed in patients with AML undergoing induction chemotherapy between 2007 and 2011. Overall, 64 Hickman® catheters and 84 peripherally inserted central catheters (PICCs) were inserted. There was a trend toward increasing use of PICCs. The rate of CVAD occlusion was higher in PICCs compared to Hickman catheters (48.2% vs. 3.2%), for a rate of 20.43 vs. 1.25 per 1000 CVAD-days (p = 0.0001). There was no significant difference in the rates of CVAD-associated thrombosis, premature removal, blood stream infection (BSI) and CVAD-related BSI. Importantly, there was no significant difference in the rate of CVAD removal between Hickman catheters and PICCs for the duration that the CVADs were in place. The choice of type of CVAD inserted into patients with newly diagnosed AML will depend on ease of catheter placement, cost, perception of frequency and severity of complications, and clinician preference.

Risk Factors for Infectious Complications in Adults with Acute Myeloid Leukemia Undergoing Induction Chemotherapy

Introduction: Febrile neutropenia is a common and potentially fatal consequence of Acute Myeloid Leukemia (AML). We performed a retrospective analysis of 97 adult AML patients (median age 67.6 y (58–78) treated between February 2000 and June 2005. Aim of the study was to evaluate risk factors for infectious complications and to identify underlying causative pathogens during first and second cycle of intensive induction chemotherapy. For statistical evaluation of the results, Students t-test, Fisher' exact test or Chi square test were performed as appropriate.Results: Of the 97 episodes 64% occurred in male patients at a median age of 67.6 years (58–78). Patients developed fever not related to cytotoxic therapy or transfusion in 77 (80%) and no fever in 20 (20%) of the episodes. Compared to patients without infectious complications patients with fever had significantly more pretreatment comorbidities (0.80±1.20 vs 1.81±1.41, p=0.0042), a prolonged period of severe neutropenia (<100/μl) (3.3±4.8 vs 13.6±8.4 days, p<0.0001) and neutropenia < 500/μl (5.6±7.2 vs 19.9±12.5 days, p<0.0001). More patients in the fever group had a central venous catheter (15% vs 47%, p=0.02, OR 5.0, CI 1.35–18,38). Clinically, this group presented more grade III/IV symptoms like mucositis (30% vs 66%, p=0.007, OR 4.6, CI 1.58–13.3), nausea (10% vs 66%, p<0.0001, OR 17.65, CI 3.8–81.97), vomiting (5% vs 49%, p=0.0008, OR 18.5, CI 5.38–19.86), diarrhea (15% vs 48%, p=0.01, OR 5.4, CI 1.46–19.9), any other gastroenterologic symptoms (5% vs 31%, p=0.03, OR 8.6, CI 1.1–68.9) and skin affections (40% vs 78%, p=0.002, OR 5.3, CI 1.86–15.0). Consequently, these patients were treated more often with interventionally intended G-CSF (15% vs. 26%, p=0.009, OR 11.7, CI 2.1–65.5) and received a higher number of antibiotic (p<0.0001) and antimycotic regimens (p<0.0001). Altogether twelve patients died within 39.9±31.1 days after the start of induction therapy. Of these, 10 deaths occurred in the fever group) with a clearly increased risk of septic reasons (p=0.04). We furthermore analyzed the effects of concomitant medication on the occurrence and outcome of febrile episodes. No difference was noted for the concomitant treatment as gastric acid suppression (p=0.43), antihistaminics (p=0.45) or corticosteroids (p=0.24) for all patients with fever. In the subgroup with proven bacterial infection the use of steroids was significantly different (p=0.009) and a trend for the use of antihistaminics was found (p=0.06). In the subgroup with an at least probable fungal infection or dead patients the use of steroids was significant (p=0.001 resp. p=0.03). No differences were noted between the first and second cycle of induction or the response to chemotherapy.Conclusion: Our data support the importance of preexisting features as the presence and number of comorbidities that have a profound impact on the risk of infectious complications during induction chemotherapy in AML while response to chemotherapy does not seem to have an impact in our relatively small cohort. Furthermore, the clinically necessary concomitant medications seem to play a role only in subgroups. As this is a retrospective analysis, confounding influences e.g. as antipyretic medication cannot be excluded. As the outcome of patients was generally not statistically different we recommend treating patients at risk prophylactically with broader spectrum antibiotics and a close clinical and laboratory monitoring.

Clinical significance of plasmacytosis in the day+14 bone marrow of patients with acute myeloid leukaemia undergoing induction chemotherapy

Background: The design of chemotherapy-induction regimens for acute myeloid leukaemia (AML) is directed towards the early elimination of bone marrow (BM) leukaemic blast cells (LBCs). Patients with AML after induction...