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Infectious complications after intensive chemotherapy with CLAG-M versus 7+3 for AML and other high-grade myeloid neoplasms.
- Source :
-
Leukemia [Leukemia] 2023 Feb; Vol. 37 (2), pp. 298-307. Date of Electronic Publication: 2022 Dec 12. - Publication Year :
- 2023
-
Abstract
- Contemporary data on infections after intensive chemotherapy for acute myeloid leukemia (AML) are scarce. Cladribine, high-dose cytarabine, G-CSF, and dose-escalated mitoxantrone ("CLAG-M") may result in higher remission rates than standard-dose cytarabine plus anthracycline ("7 + 3") but may result in more infections. We compared moderate to severe infections occurring up to 90 days after the first induction cycle for AML or other high-grade myeloid neoplasms in patients receiving CLAG-M for newly diagnosed (n = 196) or relapsed/refractory disease (n = 131) or 7 + 3 for newly diagnosed disease (n = 115). For newly diagnosed disease, microbiologically documented infections were more frequent after CLAG-M compared to 7 + 3 (adjusted rate ratio, 1.65 [95% CI, 1.06-2.58]; P = 0.03), with a cumulative incidence of 27.8% and 16.5% by day 90, respectively. Patients receiving CLAG-M for relapsed/refractory disease had the highest cumulative incidence of 50.7%. Bacterial bloodstream infections were the most frequent followed by respiratory tract infections. Among 29 patients (7%) who died, infection was a primary or contributing cause of death in 59%. These data indicate that infections continue to cause substantial morbidity in patients treated for AML, especially those treated for relapsed/refractory disease, and are more common with newer, more myelosuppressive regimens such as CLAG-M. Improved strategies for infection prevention are needed.<br /> (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)
- Subjects :
- Humans
Cladribine administration & dosage
Cladribine adverse effects
Cytarabine administration & dosage
Cytarabine adverse effects
Granulocyte Colony-Stimulating Factor administration & dosage
Granulocyte Colony-Stimulating Factor adverse effects
Respiratory Tract Infections chemically induced
Respiratory Tract Infections etiology
Sepsis chemically induced
Sepsis etiology
Sepsis microbiology
Bacterial Infections chemically induced
Bacterial Infections etiology
Anthracyclines administration & dosage
Anthracyclines adverse effects
Leukemia, Myeloid drug therapy
Leukemia, Myeloid pathology
Antineoplastic Combined Chemotherapy Protocols adverse effects
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Leukemia, Myeloid, Acute drug therapy
Leukemia, Myeloid, Acute pathology
Mitoxantrone administration & dosage
Mitoxantrone adverse effects
Infections chemically induced
Infections etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1476-5551
- Volume :
- 37
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Leukemia
- Publication Type :
- Academic Journal
- Accession number :
- 36509892
- Full Text :
- https://doi.org/10.1038/s41375-022-01786-9