Infectious complications after intensive chemotherapy with CLAG-M versus 7+3 for AML and other high-grade myeloid neoplasms.
Humans
Antineoplastic Combined Chemotherapy Protocols
/ adverse effects
Cladribine
/ administration & dosage
Cytarabine
/ administration & dosage
Granulocyte Colony-Stimulating Factor
/ administration & dosage
Leukemia, Myeloid, Acute
/ drug therapy
Mitoxantrone
/ administration & dosage
Infections
/ chemically induced
Respiratory Tract Infections
/ chemically induced
Sepsis
/ chemically induced
Bacterial Infections
/ chemically induced
Anthracyclines
/ administration & dosage
Leukemia, Myeloid
/ drug therapy
Journal
Leukemia
ISSN: 1476-5551
Titre abrégé: Leukemia
Pays: England
ID NLM: 8704895
Informations de publication
Date de publication:
02 2023
02 2023
Historique:
received:
04
09
2022
accepted:
02
12
2022
revised:
30
11
2022
pubmed:
13
12
2022
medline:
8
2
2023
entrez:
12
12
2022
Statut:
ppublish
Résumé
Contemporary data on infections after intensive chemotherapy for acute myeloid leukemia (AML) are scarce. Cladribine, high-dose cytarabine, G-CSF, and dose-escalated mitoxantrone ("CLAG-M") may result in higher remission rates than standard-dose cytarabine plus anthracycline ("7 + 3") but may result in more infections. We compared moderate to severe infections occurring up to 90 days after the first induction cycle for AML or other high-grade myeloid neoplasms in patients receiving CLAG-M for newly diagnosed (n = 196) or relapsed/refractory disease (n = 131) or 7 + 3 for newly diagnosed disease (n = 115). For newly diagnosed disease, microbiologically documented infections were more frequent after CLAG-M compared to 7 + 3 (adjusted rate ratio, 1.65 [95% CI, 1.06-2.58]; P = 0.03), with a cumulative incidence of 27.8% and 16.5% by day 90, respectively. Patients receiving CLAG-M for relapsed/refractory disease had the highest cumulative incidence of 50.7%. Bacterial bloodstream infections were the most frequent followed by respiratory tract infections. Among 29 patients (7%) who died, infection was a primary or contributing cause of death in 59%. These data indicate that infections continue to cause substantial morbidity in patients treated for AML, especially those treated for relapsed/refractory disease, and are more common with newer, more myelosuppressive regimens such as CLAG-M. Improved strategies for infection prevention are needed.
Identifiants
pubmed: 36509892
doi: 10.1038/s41375-022-01786-9
pii: 10.1038/s41375-022-01786-9
doi:
Substances chimiques
Cladribine
47M74X9YT5
Cytarabine
04079A1RDZ
Granulocyte Colony-Stimulating Factor
143011-72-7
Mitoxantrone
BZ114NVM5P
Anthracyclines
0
Types de publication
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
298-307Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Nature Limited.
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