Infection Rate and Risk Factors in Patients Treated With Azacitidine

Orero, Maite; Villegas, Carolina; Ortiz, Sebastián; Javier, Karla; Costa, S.; Pérez, Pedro Luis Hernández; Roig, M. Gómez; Linares, Mariano

doi:10.1016/j.clml.2015.07.001

Cited by 7 publications

(5 citation statements)

References 6 publications

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“…However, infection occurred as an adverse event of AZA in 53% of these patients. The incidence of infection in our cohort was higher than that of non‐HSCT patients receiving AZA previously reported, presumably because grade 3‐4 neutropenia occurred in almost all of our patients. Although AZA is generally thought to have low toxicity, pancytopenia occurred often in patients after HSCT; it is therefore mandatory that we appropriately manage infectious diseases, particularly in patients with long‐term neutropenia.…”

Section: Discussioncontrasting

confidence: 71%

Azacitidine as salvage therapy for relapsed acute myeloid leukemia/myelodysplastic syndrome after allogeneic hematopoietic stem cell transplantation

Ozawa

Fuji²,

Kawashima

et al. 2019

Adv Cell Gene Ther

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Objective: There are no established salvage therapies for relapsed myeloid malignancies after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Azacitidine (AZA) has been reported as a promising treatment in such cases. Methods:We conducted a retrospective analysis of patients at our institution who received AZA for relapse after allo-HSCT between 2014 and 2015.Results: Twenty-two patients received AZA as salvage therapy; 19 had acute myeloid leukemia and 3 had myelodysplastic syndrome. The median number of AZA cycles was 2 (range, 1-12). Seventy-seven percent of patients received AZA at a dose of 75 mg/m 2 for either 5 or 7 days. The median interval between each AZA administration was 32 days (20-63 days). Donor lymphocyte infusion (DLI) was administered in 5 patients. The median follow-up period after AZA therapy was 360 days (range, 63-805). The overall response rate was 15% in patients with non-hematological CR (Non-HCR) or hematological relapse (H-Rel) and 56% in patients with molecular relapse (M-Rel). The 1-year overall survival (OS) rates in patients with Non-HCR/H-Rel and M-Rel were 37.3% and 74.1%, respectively (P = 0.30). Patients who received DLI had favorable OS, and those with early H-Rel had poor OS. Grade 3-4 infection occurred in 12 patients. Discussion: Our study suggests that AZA ± DLI is a tolerable and promising treatment in M-Rel patients. The efficacy of AZA in H-Rel patients is limited. K E Y W O R D S acute myeloid leukemia, allogeneic stem cell transplantation, azacitidine, myelodysplastic syndrome, salvage therapy

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Section: Discussioncontrasting

confidence: 71%

Azacitidine as salvage therapy for relapsed acute myeloid leukemia/myelodysplastic syndrome after allogeneic hematopoietic stem cell transplantation

Ozawa

Fuji²,

Kawashima

et al. 2019

Adv Cell Gene Ther

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“…Prospective azacitidine trials in MDS/AML did not address the risk of IFI, although they suggested that azacitidine reduced the overall number of infectious events requiring antimicrobials compared with that of the conventional treatment regimens . Some subsequent retrospective reports have described low overall patterns of infection in such patients . One of them found a significantly higher incidence of IFI in patients receiving azacitidine following prior intensive chemotherapy compared to frontline (5/20, 25% vs. 1/44, 2.7%; P = 0.038).…”

Section: Resultsmentioning

confidence: 99%

Invasive fungal infections in AML/MDS patients treated with azacitidine: a risk worth considering antifungal prophylaxis?

Pomares

Arnán

Sánchez-Ortega

et al. 2016

Mycoses

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The aim of this study is to analyse the risk of invasive fungal infection (IFI) and the need for antifungal prophylaxis in patients with acute myeloid leukaemia and myelodysplastic syndromes (AML/MDS) treated with azacitidine. We retrospectively analysed the incidence of IFI according to EORTC-MSG criteria in 121 consecutive AML/MDS patients receiving 948 azacitidine courses (median 5, range 1-43) between June 2007 and June 2015. Four cases of IFI (two possible, one probable aspergillosis and one proven candidemia) occurred in this series. The incidence rate of proven/probable IFI was 0.21% per treatment cycle and 1.6% per patient treated for the whole series, and 0.73% per treatment cycle and 4.1% per patient treated in those with severe neutropenia. Two patients died from IFI, leading to an IFI-attributable mortality rate of 1.65% per patient and 0.21% per treatment cycle. The numbers needed to treat with prophylaxis to prevent one case of IFI are 238 azacitidine cycles or 30 patients throughout their whole treatment course, and 137 azacitidine cycles or 24 patients among those with severe neutropenia. AML/MDS patients treated with azacitidine, including those with severe prolonged neutropenia, have a very low risk of IFI which does not justify the use of antifungal prophylaxis.

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“…The usefulness of prophylactic antibiotics in the setting of AML and LITR has not been studied in a clinical investigation, notwithstanding suggestions made by AGIHO (German Society of Hematology and Medical Oncology). Current research on LITR treatment shows that regular prophylactic antibiotics are not given to these individuals [ [26] , [27] , [28] ].…”

Section: Discussionmentioning

confidence: 99%

Spectrum of infections in different regimens of post-induction chemotherapy in acute myeloid leukemia (de-novo): A comparative retrospective study

Majid,

Masoom,

Bansal

et al. 2024

Heliyon

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Infection Rate and Risk Factors in Patients Treated With Azacitidine

Cited by 7 publications

References 6 publications

Azacitidine as salvage therapy for relapsed acute myeloid leukemia/myelodysplastic syndrome after allogeneic hematopoietic stem cell transplantation

Azacitidine as salvage therapy for relapsed acute myeloid leukemia/myelodysplastic syndrome after allogeneic hematopoietic stem cell transplantation

Invasive fungal infections in AML/MDS patients treated with azacitidine: a risk worth considering antifungal prophylaxis?

Spectrum of infections in different regimens of post-induction chemotherapy in acute myeloid leukemia (de-novo): A comparative retrospective study

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