The clinical profile, management, and outcome of febrile neutropenia in acute myeloid leukemia from resource constraint settings

Abstract

Introduction: Acute myeloid leukemia (AML) is the commonest leukemia in adults. Mortality in thew first 30-days ranges from 6% to 43%, while infections account for 30–66% of early deaths. We aim to present our experience of infections in newly-diagnosed AML. Method: This prospective, observational study, was undertaken at a tertiary care hospital in Northern India. Patients with confirmed AML (bone marrow morphology and flow cytometry) and who had developed febrile neutropenia (FN), were included. Result: A total of fifty-five patients were included in the study. The median age of the patients was 47.1 years (12–71) and 28 (50.9%) were males. Fever (33, 60%) was the commonest presentation at the time of diagnosis. One or more comorbid conditions were present in 20 patients (36.36%). Infection at presentation was detected in 17 patients (30.9%). The mean duration to develop febrile neutropenia since the start of therapy was 11.24 days. With each ten-thousand increase in white blood cell (WBC) count, the mean number of days of FN development decreased by 0.35 days ( p = 0.029). Clinical and/or radiological localization was possible in 23 patients (41.81%). Thirty-four blood samples (34/242, 14.04%) from 26 patients (26/55, 47.3%) isolated one or more organisms. Gram negative bacilli (GNB) were isolated in 24 (70.58%) samples. Burkholderia cepacia (8/34, 23.52%) was the commonest organism. The number of days required to develop febrile neutropenia was inversely associated with overall survival (OS). However, when compared, there was no statistically significant difference in OS between patients developing fever on day-10 and day-25 ( p = 0.063). Thirteen patients (23.63%) died during the study period. Discussion: Low percentage of blood culture positivity and high incidence of MDR organisms are a matter of concern. Days to develop febrile neutropenia were inversely associated with overall survival (OS), emphasizing the importance of preventive measures against infections. Conclusion: Infections continues to be a major cause of morbidity and mortality among AML patients.

Survivorship Struggles: Navigating Etiologies and Clinical Parameters of Febrile Neutropenia During Induction Chemotherapy in Acute Leukemia Patients

“…In our study, severe gram-negative neutropenic sepsis and fatal outcomes are frequently linked to stubborn gram-negative organisms such as Klebsiella, Pseudomonas, and Escherichia coli, which show resistance to various drugs. This pattern is consistent with findings from other studies, which report nearly 70% of the infections in complicated febrile neutropenia are hospital-acquired [ 9 , 17 ]. The widespread challenge posed by these multidrug-resistant gram-negative organisms in causing severe infections jeopardizes patient outcomes and increases the risk for mortality [ 2 , 11 ].…”

“…Febrile neutropenia is a life-threatening oncological emergency that emphasizes the need for comprehensive research and improved therapeutic strategies to address the challenges faced by patients undergoing induction chemotherapy [ 8 , 9 ]. A developing nation such as Pakistan grapples with the complexities of the management of febrile neutropenia, where limited resources and access to advanced medical care add a layer of adversity [ 9 ]. Statistics from different developing countries report high mortality in acute leukemia, ranging between 25% to 35%, which is consistent with the results of our study [ 9 - 11 ].…”

“…A developing nation such as Pakistan grapples with the complexities of the management of febrile neutropenia, where limited resources and access to advanced medical care add a layer of adversity [ 9 ]. Statistics from different developing countries report high mortality in acute leukemia, ranging between 25% to 35%, which is consistent with the results of our study [ 9 - 11 ]. However, studies from developed countries in Europe, China, and North America report a lower mortality rate of 5% to 10% [ 3 , 6 , 12 ].…”

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

“…FN might cause severe infection, particularly in patients receiving chemotherapy for hematologic malignancies [ 5 ]. In half of the FN episodes, the infectious pathogens remain unclear, even though adequate and routine workup for infection is applied [ 5 , 6 ]. Portugal et al originally reported the D-index as a quantitative evaluation of the severity of a patient’s neutropenia [ 7 ].…”