Relevance of infections on the outcomes of patients with myelodysplastic syndromes, chronic myelomonocytic leukemia, and acute myeloid leukemia treated with hypomethylating agents: a cohort study from the GESMD.

Autor:	Vilorio-Marqués L; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain., Castañón Fernández C; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain., Mora E; Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain., Gutiérrez L; Hematology Department, Hospital Universitario de Canarias, La Laguna, Spain., Rey Bua B; Hematology Department, Hospital Clínico Universitario, Salamanca, Spain., Jiménez Lorenzo MJ; Hematology Department, Hospital Germans Trias i Pujol, Institut Català d'Oncologia-Josep Carreras, Leukemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain., Díaz Beya M; Hematology Department, Hospital Clínico Barcelona, Barcelona, Spain., Vara Pampliega M; Hematology Department, Hospital Universitario Cruces, Barakaldo, Spain., Molero A; Hematology Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain., Sánchez-García J; Hematology Department, Hospital Universitario Reina Sofía, Cordoba, Spain., Calabuig M; Hematology Department, Hospital Clínico de Valencia, Valencia, Spain., Cedena MT; Hematology Department, Hospital Universitario Doce de Octubre, Madrid, Spain., Chen-Liang T; Hematology Department, Hospital Universitario Morales Messeguer, Murcia, Spain., Díaz Santa JA; Hematology Department, Institut Catalá de Oncología, Girona, Spain., Padilla I; Hematology Department, Complejo Asistencial Universitario de León, Castilla y León, Spain., Hernández F; Hematology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain., Díez R; Hematology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain., Asensi P; Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain., Xicoy B; Hematology Department, Hospital Germans Trias i Pujol, Institut Català d'Oncologia-Josep Carreras, Leukemia Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain., Sanz G; Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain., Valcárcel D; Hematology Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain., Diez-Campelo M; Hematology Department, Hospital Clínico Universitario, Salamanca, Spain., Bernal T; Hematology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias.; Instituto Universitario de Oncología del Principado de Asturias.; Departamento de Medicina, Universidad de Oviedo.; CIBER enfermedades respiratorias, Madrid, Spain.
Jazyk:	angličtina
Zdroj:	Therapeutic advances in hematology [Ther Adv Hematol] 2022 Sep 29; Vol. 13, pp. 20406207221127547. Date of Electronic Publication: 2022 Sep 29 (Print Publication: 2022).
DOI:	10.1177/20406207221127547
Abstrakt:	Background: The consequences of infectious toxicity of hypomethylating agents (HMAs) on overall survival (OS) of patients diagnosed with high-risk myeloid neoplasms have not been thoroughly investigated. Objectives: We aimed to evaluate whether infectious events (IEs) negatively influenced the results of HMA treatment in a real-world setting. Design: Observational study. Methods: We obtained data from 412 non-selected consecutive patients from 23 Spanish hospitals who were diagnosed with high-risk myelodysplastic syndrome, chronic myelomonocytic leukemia, or acute myeloid leukemia and were treated with HMA. HMAs received after chemotherapy or stem cell transplant were excluded. All IEs were recorded. Outcomes included OS, modifications to the pre-planned treatment, incidence and characteristics of IEs, hospitalization, red blood cell transfusions, and factors associated with infection. Results: The rate of infection was 1.2 per patient/year. Next-cycle delay ( p = 0.001) and hospitalizations ( p = 0.001) were significantly influenced by IEs. Transfusion requirements during each cycle were significantly higher after infection compared with cycles without infection (coefficient = 1.55 [95% confidence interval (CI) = 1.26-1.84], p < 0.001). The median number of cycles was lower in patients experiencing any infection during the first four cycles (5 [3-8] versu 8 [5-16], p < 0.001). In the multivariable analysis, factors associated with lower OS were having any infection during the first four cycles (hazard ratio (HR) = 1.43 [95% CI = 1.09-1.88], p = 0.01), bone marrow blasts ⩾30% (HR = 2.13 [95% CI = 1.14-3.96], p = 0.01), adverse cytogenetics (HR = 1.70 [95% CI = 1.30-2.24], p < 0.001), and platelet count <50 × 10 ⁹ /l (HR = 1.69 [95% CI = 1.3-2.2], p < 0.001). BM blasts >20% (HR = 1.57 [95% CI = 1.19-2.01], p < 0.001) and adverse cytogenetics (HR = 1.7 [95% CI = 1.35-2.14], p < 0.001) were associated with infection, whereas hemoglobin >9 g/dl (HR = 0.65 [95% CI = 0.51-0.82], p < 0.001) and higher platelet count (HR = 0.997 [95% CI = 0.996-0.998], p = 0.016) protected from it. Conclusion: HMA infectious toxicity worsens OS, hinders the adherence to antineoplastic treatment and results in significant morbidity. Preventive strategies are fundamental in vulnerable patients. (© The Author(s), 2022.)
Databáze:	MEDLINE
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