Febrile events in acute lymphoblastic leukemia: a prospective observational multicentric SEIFEM study (SEIFEM-2012/B ALL)

Abstract

The purpose of the present study is to estimate the current incidence of febrile events (FEs) and infectious episodes in acute lymphoblastic leukemia (ALL) and evaluate the outcome. We analyzed data on all FEs in a cohort of patients affected by ALL admitted to 20 Italian hematologic centers during 21 months of observation from April 1, 2012 to December 31, 2013. Data about treatment phase, steroids, neutropenia, type and site of infection, and outcome of infection were collected. The population comprehended 271 ALL adult patients. Median age was 46 years old (range 19-75), M/F 1.1:1. We collected 179 FEs occurring during 395 different phases of treatment in 127 patients (45.3% incidence): remission induction treatment 53.1%, consolidation/maintenance 35.7%, treatment for a first or second relapse 44.3%, and refractory disease 85.7%. The incidence of FUO (fever of unknown origin) was 55/395 (13.9%). In the remaining cases, bacteria caused 92 FEs (23.2%), fungi 17 (4.3%), viruses 5 (1%). Mixed infections occurred in 10 cases mainly fungal+bacterial (9/10 cases). Neutropenia was mostly present at onset of FE (89.9% of FEs). Mortality rate was 11.7% (21/179) while 16 deaths occurred with evidence of infection (8.9%). Age > 60 years, neutropenia, poor performance status, steroids, refractory disease, and mixed infections significantly correlated with infection-related mortality. A statistically significant association with mortality was observed also for pulmonary localization and bacteremia. Our study describes the real-life epidemiological scenario of infections in ALL and identifies a subset of patients who are at higher risk for infection-related mortality.

Efficacy of levofloxacin as an antibacterial prophylaxis for acute leukemia patients receiving intensive chemotherapy: a systematic review and meta-analysis

“…The incidence of FN in acute myeloid leukemia (AML) patients following such chemotherapy has been reported to range from 60% to 80%. The figures have also been high in acute lymphoblastic leukemia (ALL) patients, with reported FN rates of 40-60% [1][2][3][4]. Several studies revealed that the use of ciprofloxacin, a particular fluoroquinolone prophylaxis, in patients with various types of hematologic malignancies decreased the FN rate and reduced the rate of blood stream infections [5][6][7].…”

Infectious complications in patients with acute leukemia according to the duration of neutropenia

“…Риск инфекционных осложнений увеличивался до 60% придлительностигранулоцитопениивтечение3нед и достигал 100%, если число гранулоцитов в крови составляломенее100 / мм 3 .Прииспользованиисовре-менныхпрограммХТмыполучилианалогичныерезультаты. Инфекционные осложнения возникали статистическизначимочащеубольныхсгранулоцитопениейвсравнениисбольнымибезнее(80%про-тив6 %,p<0,0001),априувеличениипериодагранулоцитопении от 1-7 до 22 дней и более частота инфекционныхосложненийвозрасталас52до96%, p<0,0001.Сопоставимыеданныебылипредставлены вмногоцентровомисследованииизИталии,опубли-кованномв2018г.ивключавшем271больногоОЛЛ [6].Вэтойработев161(89,9%)из179случаевинфекциирегистрировалигранулоцитопению(гранулоци-товвкровименее500 / мм 3 ),ав124(69,2%)эпизодах инфекциигранулоцитопениябылаглубокойипродолжительной (гранулоцитов в крови менее 100 / мм 3 втечение10днейиболее).…”

Infectious complications during monoclonal antibodies treatments and cell therapies in Acute Lymphoblastic Leukemia

“…Among patients with ALL, 45% experience infectious complications during the course of the disease [4] . Most of the infections in ALL patients are bacterial (40%), mostly gram-negative, and they are more frequent during induction therapy: 53% of patients experience and infectious complication during induction therapy and 44.3% at relapse.…”

“…Most of the infections in ALL patients are bacterial (40%), mostly gram-negative, and they are more frequent during induction therapy: 53% of patients experience and infectious complication during induction therapy and 44.3% at relapse. Refractory patients have the highest incidence of infection rate (85.7%), whereas patients in complete remission the lowest (35.7%) [4] .…”