Cellulitis with Leukocytopenia as an Initial Sign of Acute Promyelocytic Leukemia

Sakamoto, Sachiko; Oiso, Naoki; Emoto, Masakatsu; Uchida, Shusuke; Hirao, Ayaka; Tatsumi, Yoichi; Matsumura, Itaru; Kawada, Akira

doi:10.1159/000337195

Cited by 1 publication

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“…Pneumonia, sinusitis and cellulitis remained significantly associated with CML following the exclusion of >6 years of claims data. Reflective of their commonality within the community these infections are frequently seen in patients with haematological malignancies[24,25] with sinusitis suggested as an underlying disease [26,27]. The slow progression of CML is often asymptomatic in the early stages of disease progression.…”

Section: Discussionmentioning

confidence: 99%

Community-acquired infections and their association with myeloid malignancies

Titmarsh

McMullin

McShane

et al. 2014

Cancer Epidemiology

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Introduction Antigenic stimulation is a proposed aetiologic mechanism for many haematological malignancies. Limited evidence suggests that community-acquired infections may increase the risk of acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS). However, associations with other myeloid malignancies including chronic myeloid leukaemia (CML) and myeloproliferative neoplasms (MPNs) are unknown. Material and Methods Using the Surveillance, Epidemiology and End Result (SEER)-Medicare database, fourteen community-acquired infections were compared between myeloid malignancy patients [AML (n=8,489), CML (n=3,626) diagnosed 1992–2005; MDS (n=3,072) and MPNs (n=2,001) diagnosed 2001–2005; and controls (200,000 for AML/CML and 97,681 for MDS/MPN]. Odds ratios (ORs) and 95% confidence intervals were adjusted for gender, age and year of selection excluding infections diagnosed in the 13 month period prior to selection to reduce reverse causality. Results Risk of AML and MDS respectively, were significantly associated with respiratory tract infections, bronchitis (ORs 1.20 [95% CI: 1.14–1.26], 1.25 [95% CI: 1.16–1.36]), influenza (ORs 1.16 [95% CI:1.07–1.25], 1.29 [95% CI: 1.16–1.44]), pharyngitis (ORs 1.13 [95% CI: 1.06–1.21], 1.22 [95% CI: 1.11–1.35]), pneumonia (ORs 1.28 [95% CI: 1.21–1.36], 1.52 [95% CI: 1.40–1.66]), sinusitis (ORs 1.23 [95% CI: 1.16–1.30], 1.25 [95% CI: 1.15–1.36]) as was cystitis (ORs 1.13 [95% CI: 1.07–1.18], 1.26 [95% CI: 1.17–1.36]). Cellulitis (OR 1.51 [95% CI: 1.39–1.64]), herpes zoster (OR 1.31 [95% CI: 1.14–1.50]) and gastroenteritis (OR 1.38 [95% CI: 1.17–1.64]) were more common in MDS patients than controls. For CML, associations were limited to bronchitis (OR 1.21 [95% CI: 1.12–1.31]), pneumonia (OR 1.49 [95% CI: 1.37–1.62]), sinusitis (OR 1.19 [95% CI: 1.09–1.29]) and cellulitis (OR 1.43 [95% CI: 1.32–1.55]) following Bonferroni correction. Only cellulitis (OR 1.34 [95% CI: 1.21–1.49]) remained significant in MPN patients. Many infections remained elevated when more than 6 years of preceding claims data were excluded. Discussion Common community-acquired infections may be important in the malignant transformation of the myeloid lineage. Differences in the aetiology of classic MPNs and other myeloid malignancies require further exploration.

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