EPIDEMIOLOGY OF FEBRILE EVENTS (FE) IN NEUTROPENIC PATIENTS (PTS) WITH ACUTE LYMPHOBLASTIC LEUKEMIA (ALL) TREATED BY
(Abstract release date: 05/19/16)
EHA Library. Okhmat V. 06/09/16; 134788; PB1888
Dr. Vladimir Okhmat
Contributions
Contributions
Abstract
Abstract: PB1888
Type: Publication Only
Background
Hematological patients with acute leukemia undergoing intensive myelosupressive treatment are at high risk for severe, life-threatening infections.
Aims
To evaluate the epidemiology of FE in neutropenic pts with ALL on different chemotherapy phases (CP).
Methods
Single-center, prospective observational study in adults with newly diagnosed ALL treated by «ALL-2009» protocol (NCT01193933) was performed from Jan 2013 till Jan 2016. Pts were followed up for 180 days.
Results
Total of 44 pts were enrolled (22 - male, 22 - female; median age 26 (17-61). On admission hyperleukocytosis was in 25% (11/44) of pts, ECOG score≥ 3 had 61% (27/44).These pts had 271 CP (induction I – 43, induction II – 42, consolidation I – 42, consolidation II - 41, consolidation III – 40, consolidation IV - 33, consolidation V - 30). Neutropenia was in 33% of CP, median duration 9 (2 - 45) days, more frequent and prolonged in induction then in consolidation (58% vs 22%, p<0.0001; 19 vs 6 days, p<0.000001).FE occurred in 18% (48/271) of CP, more often in induction than in consolidation (36% vs 9%, p<0.0001).FE (48) reasons were: fever of unknown origin (FUO) in 29% (14), clinically documented infection (CDI) in 48% (pneumonia - 17, cellulitis - 6) and bloodstream infection (BSI) in 23% (11).Among BSI pathogens Gram-negative bacteria were in 77% (E. coli – 3, Salmonella spp. – 3, K. pneumonia – 2, E. asburae – 1, C. youngae - 1), Gram-positive bacteria were in 23% (B. cereus – 1, S. aureus – 2). BSI was polymicrobial in 18% (2/11).Rate of invasive mycoses (IM) was 14% (6/44): 2 - invasive aspergillosis, probable (IA), 1 - mixed IA, probable plus mucormycosis, 3 - hepatosplenic candidiasis. All IM occurred in induction. Nobody had IM in consolidation (p=0.0002).Overall 180 days mortality was 5% (2/44), 1 patient died in induction (1 – IA plus mucormycosis) and 1 in follow-up period (BSI due to Salmonella spp.).
Conclusion
Our study showed moderate rate of infections (18%) in ALL pts treated by «ALL-2009» protocol. FE were more frequent in induction than in consolidation (36% vs 9%). Most pts (71%) had CMI and BSI. IM occurred only in induction. Overall 180 days mortality was relatively low (5%).
Session topic: E-poster
Keyword(s): Acute lymphoblastic leukemia, Febrile neutropenia, Infection
Type: Publication Only
Background
Hematological patients with acute leukemia undergoing intensive myelosupressive treatment are at high risk for severe, life-threatening infections.
Aims
To evaluate the epidemiology of FE in neutropenic pts with ALL on different chemotherapy phases (CP).
Methods
Single-center, prospective observational study in adults with newly diagnosed ALL treated by «ALL-2009» protocol (NCT01193933) was performed from Jan 2013 till Jan 2016. Pts were followed up for 180 days.
Results
Total of 44 pts were enrolled (22 - male, 22 - female; median age 26 (17-61). On admission hyperleukocytosis was in 25% (11/44) of pts, ECOG score≥ 3 had 61% (27/44).These pts had 271 CP (induction I – 43, induction II – 42, consolidation I – 42, consolidation II - 41, consolidation III – 40, consolidation IV - 33, consolidation V - 30). Neutropenia was in 33% of CP, median duration 9 (2 - 45) days, more frequent and prolonged in induction then in consolidation (58% vs 22%, p<0.0001; 19 vs 6 days, p<0.000001).FE occurred in 18% (48/271) of CP, more often in induction than in consolidation (36% vs 9%, p<0.0001).FE (48) reasons were: fever of unknown origin (FUO) in 29% (14), clinically documented infection (CDI) in 48% (pneumonia - 17, cellulitis - 6) and bloodstream infection (BSI) in 23% (11).Among BSI pathogens Gram-negative bacteria were in 77% (E. coli – 3, Salmonella spp. – 3, K. pneumonia – 2, E. asburae – 1, C. youngae - 1), Gram-positive bacteria were in 23% (B. cereus – 1, S. aureus – 2). BSI was polymicrobial in 18% (2/11).Rate of invasive mycoses (IM) was 14% (6/44): 2 - invasive aspergillosis, probable (IA), 1 - mixed IA, probable plus mucormycosis, 3 - hepatosplenic candidiasis. All IM occurred in induction. Nobody had IM in consolidation (p=0.0002).Overall 180 days mortality was 5% (2/44), 1 patient died in induction (1 – IA plus mucormycosis) and 1 in follow-up period (BSI due to Salmonella spp.).
Conclusion
Our study showed moderate rate of infections (18%) in ALL pts treated by «ALL-2009» protocol. FE were more frequent in induction than in consolidation (36% vs 9%). Most pts (71%) had CMI and BSI. IM occurred only in induction. Overall 180 days mortality was relatively low (5%).
Session topic: E-poster
Keyword(s): Acute lymphoblastic leukemia, Febrile neutropenia, Infection
Abstract: PB1888
Type: Publication Only
Background
Hematological patients with acute leukemia undergoing intensive myelosupressive treatment are at high risk for severe, life-threatening infections.
Aims
To evaluate the epidemiology of FE in neutropenic pts with ALL on different chemotherapy phases (CP).
Methods
Single-center, prospective observational study in adults with newly diagnosed ALL treated by «ALL-2009» protocol (NCT01193933) was performed from Jan 2013 till Jan 2016. Pts were followed up for 180 days.
Results
Total of 44 pts were enrolled (22 - male, 22 - female; median age 26 (17-61). On admission hyperleukocytosis was in 25% (11/44) of pts, ECOG score≥ 3 had 61% (27/44).These pts had 271 CP (induction I – 43, induction II – 42, consolidation I – 42, consolidation II - 41, consolidation III – 40, consolidation IV - 33, consolidation V - 30). Neutropenia was in 33% of CP, median duration 9 (2 - 45) days, more frequent and prolonged in induction then in consolidation (58% vs 22%, p<0.0001; 19 vs 6 days, p<0.000001).FE occurred in 18% (48/271) of CP, more often in induction than in consolidation (36% vs 9%, p<0.0001).FE (48) reasons were: fever of unknown origin (FUO) in 29% (14), clinically documented infection (CDI) in 48% (pneumonia - 17, cellulitis - 6) and bloodstream infection (BSI) in 23% (11).Among BSI pathogens Gram-negative bacteria were in 77% (E. coli – 3, Salmonella spp. – 3, K. pneumonia – 2, E. asburae – 1, C. youngae - 1), Gram-positive bacteria were in 23% (B. cereus – 1, S. aureus – 2). BSI was polymicrobial in 18% (2/11).Rate of invasive mycoses (IM) was 14% (6/44): 2 - invasive aspergillosis, probable (IA), 1 - mixed IA, probable plus mucormycosis, 3 - hepatosplenic candidiasis. All IM occurred in induction. Nobody had IM in consolidation (p=0.0002).Overall 180 days mortality was 5% (2/44), 1 patient died in induction (1 – IA plus mucormycosis) and 1 in follow-up period (BSI due to Salmonella spp.).
Conclusion
Our study showed moderate rate of infections (18%) in ALL pts treated by «ALL-2009» protocol. FE were more frequent in induction than in consolidation (36% vs 9%). Most pts (71%) had CMI and BSI. IM occurred only in induction. Overall 180 days mortality was relatively low (5%).
Session topic: E-poster
Keyword(s): Acute lymphoblastic leukemia, Febrile neutropenia, Infection
Type: Publication Only
Background
Hematological patients with acute leukemia undergoing intensive myelosupressive treatment are at high risk for severe, life-threatening infections.
Aims
To evaluate the epidemiology of FE in neutropenic pts with ALL on different chemotherapy phases (CP).
Methods
Single-center, prospective observational study in adults with newly diagnosed ALL treated by «ALL-2009» protocol (NCT01193933) was performed from Jan 2013 till Jan 2016. Pts were followed up for 180 days.
Results
Total of 44 pts were enrolled (22 - male, 22 - female; median age 26 (17-61). On admission hyperleukocytosis was in 25% (11/44) of pts, ECOG score≥ 3 had 61% (27/44).These pts had 271 CP (induction I – 43, induction II – 42, consolidation I – 42, consolidation II - 41, consolidation III – 40, consolidation IV - 33, consolidation V - 30). Neutropenia was in 33% of CP, median duration 9 (2 - 45) days, more frequent and prolonged in induction then in consolidation (58% vs 22%, p<0.0001; 19 vs 6 days, p<0.000001).FE occurred in 18% (48/271) of CP, more often in induction than in consolidation (36% vs 9%, p<0.0001).FE (48) reasons were: fever of unknown origin (FUO) in 29% (14), clinically documented infection (CDI) in 48% (pneumonia - 17, cellulitis - 6) and bloodstream infection (BSI) in 23% (11).Among BSI pathogens Gram-negative bacteria were in 77% (E. coli – 3, Salmonella spp. – 3, K. pneumonia – 2, E. asburae – 1, C. youngae - 1), Gram-positive bacteria were in 23% (B. cereus – 1, S. aureus – 2). BSI was polymicrobial in 18% (2/11).Rate of invasive mycoses (IM) was 14% (6/44): 2 - invasive aspergillosis, probable (IA), 1 - mixed IA, probable plus mucormycosis, 3 - hepatosplenic candidiasis. All IM occurred in induction. Nobody had IM in consolidation (p=0.0002).Overall 180 days mortality was 5% (2/44), 1 patient died in induction (1 – IA plus mucormycosis) and 1 in follow-up period (BSI due to Salmonella spp.).
Conclusion
Our study showed moderate rate of infections (18%) in ALL pts treated by «ALL-2009» protocol. FE were more frequent in induction than in consolidation (36% vs 9%). Most pts (71%) had CMI and BSI. IM occurred only in induction. Overall 180 days mortality was relatively low (5%).
Session topic: E-poster
Keyword(s): Acute lymphoblastic leukemia, Febrile neutropenia, Infection
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