c-D-index is a risk factor for prolonged febrile neutropenia during chemotherapy in patients with acute myeloid leukemia

Kubo, Hiroyuki; Imataki, Osamu; Kubo, Yukiko; Uemura, Makiko; Kadowaki, Norimitsu

doi:10.1007/s10147-018-01384-9

Cited by 4 publications

(6 citation statements)

References 17 publications

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“…Regarding the infection focus, two later clinical investigations did not find the c-D-index to be a useful predictor of pulmonary infection during consolidation chemotherapy with high-dose cytarabine (Ara-C) [ 9 ] or after reduced-intensity SCT [ 10 ]. When we have assessed the predictive value of the D-indices for infection focus, they failed to be of significant value both in our previous reports [ 17 ] and this trial. One of the reasons for this was the small sample size.…”

Section: Discussionmentioning

confidence: 71%

“…However, these patients are predisposed to FN; hence, an index that predicts only pulmonary infection [ 9 , 10 ] is deemed not ideal. Previously, we have reported positive relation between the c-D-index and prolonged neutropenia in an adult population [ 17 ]. While the D-index did not predict the onset and severity of FN, the c-D-index was associated with prolonged FN.…”

Section: Introductionmentioning

confidence: 99%

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c-D-index at day 11 can predict febrile neutropenia during chemotherapy in acute myeloid leukemia

et al. 2022

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Acute myeloid leukemia (AML) often requires long-term intensive chemotherapy for its cure. During chemotherapy, the patient always experiences neutropenia with readings below 500 cells/μL; this is often accompanied by pyrexia with a temperature of more than 101°F. This combination of neutropenia and fever is called febrile neutropenia (FN). A tool to sum up the daily severity of a patient’s neutropenia, the “D-index,” has been validated in some specific clinical settings. In this study, we examined whether the D-index is a useful predictor of the onset of FN. We recruited consecutive patients treated with induction and consolidation chemotherapy for newly diagnosed AML. We gathered all the FN events and their clinical background data retrospectively. Patients’ background, such as pre-existing conditions and disease status before the treatment, were analyzed using multivariate methods. All FN events during chemotherapy were evaluated for infection focus and causative organism. A total cohort of 51 cases (25 women, 26 men; median age 51 years, range 18–74) was analyzed. They displayed 171 neutropenic events (115 FN and 56 afebrile episodes) during chemotherapy, and complete neutropenic events were used in this study. Sensitivity and specificity analysis showed that the most useful cutoff value to predict the onset of FN was a cumulative D-index at day 11 (c-D11-index) of 718. The cumulative incidence of FN during chemotherapy was significantly higher in the group with c-D11-index ≥710 (80%) than in the group with c-D11-index <710 (39%) (P < 0.0001). Through multivariate analysis, the presence of diabetes mellitus and the c-D11-index were extracted as contributing factors to the onset of FN (P = 0.0087 and 0.0002, respectively). In conclusion, we can predict that AML patients receiving chemotherapy will experience the complication of FN when the c-D-index at day 11 is >710, with an odds ratio of 2.1.

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Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

c-D-index at day 11 can predict febrile neutropenia during chemotherapy in acute myeloid leukemia

et al. 2022

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“…The use of D-index in the context of other neutropenic complications was also reported. In AML patients with febrile neutropenia who received both induction and consolidation phases of chemotherapy, the c-D-index was initially found to be an independent risk factor for prolonged febrile neutropenia [ 22 ]. Subsequently, the study from the same group revealed that the c-D-index on Day 11 at 710 or above was associated with a higher cumulative incidence of febrile neutropenia than those with a c-D-index less than 710 (80% vs. 39%) [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

D-index and invasive fungal infections (IFIs) in adult acute myeloid leukemia (AML) patients with the first episode of febrile neutropenia

Rattanathammethee,

Munsamai,

Punnachet

et al. 2023

PLoS ONE

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Introduction This study aimed to evaluate the performance of the D-index, a calculated measure of neutropenic burden, in predicting the risk of invasive fungal infections (IFIs) in acute myeloid leukemia (AML) patients. Methods A retrospective study of adult AML patients who received the first induction chemotherapy and developed febrile neutropenia was conducted. Clinical characteristics, laboratory data, and the calculation of the D-index and cumulative D-index (c-D-index) were collected and analyzed between patients with and without IFIs. Results A total of 101 patients were included, with 16 (15.8%) patients who developed IFIs. Clinical characteristics, antifungal prophylaxis, and AML cytogenetic risk were similar between patients with or without IFIs. The results showed that the D-index and c-D-index were more effective in predicting IFIs than the duration of neutropenia. With the D-index cutoff of 7083, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 81.3%, 83.5%, 48.2%, and 95.9%, respectively. c-D-index at 5625 revealed sensitivity, specificity, PPV, and NPV for IFIs of 68.8%, 68.2%, 28.9%, and 92.1%, respectively. Using this cutoff of c-D-index, patients without IFIs were overtreated with an antifungal regimen in 45 (52.9%) cases. Conclusion The D-index and c-D-index were helpful indicators for defining the risk of IFIs in AML patients with febrile neutropenia.

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“…The D-index was designed as a mathematical tool that evaluates the severity of neutropenia by determining the accumulated deficit of the absolute neutrophil count < 500 cells/μL during the neutropenia episode [ 11 , 12 ]. It allows discrimination between patients with the exact duration of neutropenia but with different intensities of neutropenia [ 12 , 13 ].…”

Section: Methodsmentioning

confidence: 99%

D-index as a Risk Factor for Invasive Fungal Infections in Patients With Acute Lymphoblastic Leukemia From a Reference Hematology Center in Bogota

Domínguez¹,

Enciso²,

Cuervo³

et al. 2023

Cureus

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Introduction Patients with hematologic malignancies are susceptible hosts for the development of invasive fungal infection (IFI), one of the main life-threatening infectious complications faced by these patients. Currently, we have antifungal prophylaxis strategies and antifungal treatment schemes and we recognize that the main risk factor involved is profound and prolonged neutropenia. D-index and cumulative D-index are quantitative parameters, which determine the magnitude of neutropenia, as a function of duration and depth and their value correlates with the occurrence of IFI. Material and methods A case-control study in patients older than 18 years with acute lymphoblastic leukemia (ALL) was admitted between 2009 and 2019 at the National Cancer Institute for induction, consolidation and salvage chemotherapy. Results A total of 167 patients were included, who received 288 cycles of chemotherapy, the latter were considered the unit of analysis. A generalized estimating equations (GEE) model was designed to analyze correlated data; three quantitative and continuous variables of interest were included in this model: age (years), D-index and deep neutropenia (days). For the population D-index, an odds ratio (OR) = 1.000227 (95% CI 1.0002-1.0004); p < 0.001 was obtained. Conclusion D-index is associated with the development of IFI in patients with ALL, with an exponential increase in OR as the absolute value of the D-index increases.

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c-D-index is a risk factor for prolonged febrile neutropenia during chemotherapy in patients with acute myeloid leukemia

Cited by 4 publications

References 17 publications

c-D-index at day 11 can predict febrile neutropenia during chemotherapy in acute myeloid leukemia

c-D-index at day 11 can predict febrile neutropenia during chemotherapy in acute myeloid leukemia

D-index and invasive fungal infections (IFIs) in adult acute myeloid leukemia (AML) patients with the first episode of febrile neutropenia

D-index as a Risk Factor for Invasive Fungal Infections in Patients With Acute Lymphoblastic Leukemia From a Reference Hematology Center in Bogota

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