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

Author:

Mishra Kundan1ORCID,Kumar Suman2,Ninawe Sandeep3,Bahl Rajat1,Meshram Ashok4,Singh Kanwaljeet5,Jandial Aditya6,Sahu Kamal Kant7ORCID,Sandal Rajeev8,Khera Sanjeev9,Yanamandra Uday1,Khurana Harshit10,Kumar Rajiv114,Kapoor Rajan1112,Sharma Sanjeevan1113,Singh Jasjit1114,Das Satyaranjan1115,Ahuja Ankur5,Somasundaram Venkateshan5,Chaterjee Tathagat5

Affiliation:

1. Department of Clinical Hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi, India

2. DM (Clinical Hematology), Prof & Head of the Department, Department of Clinical Hematology & Stem Cell Transplant, Army Hospital (Research & Referral), Delhi, 110010, India

3. Department of Microbiology, Army Hospital (Research & Referral) Delhi, India

4. Department of Internal Medicine, INHS Asvini, Mumbai, MH, India

5. Department of Lab Sciences and Molecular Medicine, Army Hospital (Research & Referral) Delhi, India

6. Department of Internal Medicine, PGIMER, Chandigarh, CH, India

7. Hematology & Medical Oncology Fellow (PGY 4), Huntsman Cancer Institute, University of Utah, Salt Lake City, 84112, Utah, USA

8. Department of Radiotherapy and Oncology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

9. Department of Pediatrics, Army Hospital (Research & Referral) Delhi, India

10. Department of Internal Medicine, Command Hospital (Air Force), Bangaluru, KA, India

11. Department of Clinical hematology and Stem Cell Transplant, Army Hospital (Research & Referral) Delhi

12. Department of Internal Medicine, Command Hospital (Eastern Command), Kolkata, India

13. Department of Internal Medicine, Command Hospital (Central Command), Lucknow, UP, India

14. Department of Internal Medicine, Command Hospital (Western Command), Chandimandir, India

15. Department of Internal Medicine, Command Hospital (Southern Command), Pune, India

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.

Publisher

SAGE Publications

Subject

Pharmacology (medical),Infectious Diseases

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