Evaluation of the incidence of infectious complications during induction therapy in adult patients with newly diagnosed acute myeloid leukemia


Fornagiel, Szymon


infectious complications ; acute myeloid leukemia


Infectious complications are one of the most common sequelae among cancer patients receiving chemotherapy. The goal of this study was to determine whether any of the analyzed regimens: DA, DAC, DAF affect the incidence, etiology and severity of infectious complications and subsequently their influence on treatment outcome in adult patients with newly diagnosed acute myeloid leukemia..This study was a part of the multicenter, randomized, phase III PALG AML 1/2004 study. The main aim of this study was to evaluate the influence of a purine analog addition (cladribine or frudarabine) to standard induction regimens on complete remission rate and overall survival. If no contraindications were present and all inclusion criteria were fulfilled all patients were centrally randomized to receive one of the above three induction regimens. A cohort of 92 AML patients (48 female and 44 male) with a median age 39.6 years was analyzed in the Department of Hematology of the University Hospital in Cracow between 2004 and 2008. Data were obtained using the “Infectious Complications Form” and the patients disease history.Based on the analysis performed at the Department of Hematology infectious complications were found in every type of induction course. The lowest frequency of febrile episodes was reported in the DAC group (p=0.005), simultaneously this group was considered as the most traceable i ; n regard to pathogen detection (p=0.001). In all treatment arms Gram-positive bacteria tended to be the most common pathogens. Concurrently not one single species was prevailing. The incidence of major infections was similar in every treatment group. The course of infectious complications that appeared during induction therapy in acute myeloid leukemia patients was independent of the chemotherapy regimen. Also, the time necessary for resolution of infection hallmarks (clinical signs, body temperature and bacterial growth) was comparable in every treatment group except for pulmonary tissue consolidation secondary to lower respiratory tract inflammation. In the DAC arm the time of resolution of changes revealed in chest radiograph imagination was the longest. ; Every patient received first-line (prophylactic) antibiotic therapy, whereas addition of glycopeptides/linezolid and second-line antibiotics was observed most frequently in the DA arm. There wasalso no difference in G-SCF, immunoglobulins, antifungal and antiviral therapy among the analyzed groups.In every treatment arm the rate of hematopoetic restitution and peripheral morphology normalization was similar and amounted to over 70%. The median duration of IV degree neutropenia after completing cytostatic infusion was 17 days and did not differ in particular treatment lines. The highest CR rate was achieved among the patien ; ts receiving the DAC regimen (64.52%), but results observed in other group did not draw a statistical distinction (p=0.69).The DA, DAC and DAF regimens analyzed in this study were considered efficient therapeutic approaches as induction therapy in patients with newly diagnosed acute myeloid leukemia. The incidence, spectrum and outcome of infectious complications did not reach a significant difference among respective treatment groups.Investigations performed in this study led to the realization of the set aim. Concurrently they implicate the relevance of studies evaluating the course of infectious complications during induction chemotherapy in patients with new diagnosed acute myeloid leukemia.

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2 - studia doktoranckie

Degree discipline:

hematologia ; onkologia

Degree grantor:

Wydział Lekarski


Skotnicki, Aleksander



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Praca doktorska

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