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Clin Lymphoma Myeloma Leuk. 2015 Jun;15(6):e95-9. doi: 10.1016/j.clml.2015.02.030. Epub 2015 Mar 5.

Higher infection rate after 7- compared with 5-day cycle of azacitidine in patients with higher-risk myelodysplastic syndrome.

Author information

1
Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. Electronic address: y_ofran@rambam.health.gov.il.
2
Department of Hematology, Kaplan Medical Center, Rehovot, Israel.
3
Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Tel Aviv University, Tel Aviv, Israel.
4
Department of Hematology, Emek Medical Center, Afula, Israel.
5
Hematology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
6
Hematology Institute, Wolfson Medical Center, Holon, Israel.
7
Hematology Institute, Sourasky Medical Center, Tel Aviv, Israel.
8
Department of Hematology, Sanz Medical Center - Laniado Hospital, Netanya, Israel.
9
Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel; Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel.
10
Department of Hematology, Ziv Medical Center, Zefat, Israel.
11
Department of Hematology, Barzilai Medical Center, Ashkelon, Israel.
12
Institution of Hematology, Soroka University Medical Center, Beer-Sheba, Israel.
13
Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel.
14
Hematology Unit, Assaf Harofe Medical Center, Zerifin, Israel.
15
Department of Hematology, Western Galilee Hospital, Nahariya, Israel.
16
Hematology Unit, Meir Medical Center, Kfar Saba, Israel.
17
Hematology Unit, Poria Medical Center, Hedera, Israel.
18
Division of Hematology, Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Tel Aviv, Israel.
19
Quality of Care Unit, Rambam Health Care Campus, Haifa, Israel.
20
Department of Medicine, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.

Abstract

INTRODUCTION:

Azacitidine (AZA) dose reduction is a common practice in cytopenic patients. However, a correlation between AZA dose and infection complications has never been studied.

PATIENTS AND METHODS:

Higher-risk patients with myelodysplastic syndrome or acute myeloid leukemia treated with AZA in 18 Israeli hospitals between the years 2008 and 2011 were included in a former national survey. To reveal the effect of AZA dosage on infection risk we limited our analysis to the infection rate after the first AZA dose alone. We excluded subsequent cycles of AZA from the analysis, because infectious events during these cycles might be related to other cofactors such as disease response to AZA therapy.

RESULTS:

After the first AZA cycle, infectious events were more frequent after doses of 75 mg/m(2) for 7 days than 75 mg/m(2) for 5 days (36/106 [34%] and 10/67 [14.9%], respectively; P = .008), regardless of the patient's age. Of the 46 recorded infectious events, the causative pathogen was identified as bacterial in 25 (54.3%) and as viral or fungal in 2 (4.3%) and 2 (4.3%) cases, respectively. No pathogen was identified in 17 (37%) cases. Infections were significantly more prevalent among patients who presented with platelet counts < 20,000 (43.6% vs. 23.6%; P = .012) and poor risk cytogenetics (40.7% vs. 19.8%; P = .008).

CONCLUSION:

Reduction of AZA dose might decrease infection rate and therefore should be considered in patients with high infection risk.

KEYWORDS:

Azacitidine; Cytogenetics; Dose adjustment; Infection; Myelodysplastic syndrome

PMID:
25819366
DOI:
10.1016/j.clml.2015.02.030
[Indexed for MEDLINE]

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